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Monday - Friday: 8:00 am - 6:00 pm
Saturday & Sunday: CLOSED
Call Us:
(407) 896-0941
Text Us:
(407) 502-3570
Email Us:
[email protected]
Fax Us:
(407) 896-0535
After Hours Emergencies:
(407) 644-4449
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Pre-Exam Check List Form
Owner(s) Name
Email address
Pet’s Name
Reason for today’s visit?
Current Medication(s) / Supplements
Heartworm Prevention used:
Flea/Tick Control used:
Pet’s Diet:
How often:
How much:
Treats:
Is your pet:
Indoor ONLY
Outdoor ONLY
Indoor/Outdoor
Does your pet go to:
Groomer?
Yes
No
Day Care?
Yes
No
Travel?
Yes
No
Dog Park?
Yes
No
Boarding?
Yes
No
Swim in lake, pond, beach?
Yes
No
Has your pet ever had a reaction to vaccines?
Yes
No
Explain further if needed
Has there been any recent vomiting?
Yes
No
Explain further if needed.
Has there been any recent diarrhea?
Yes
No
Explain further if needed
Has there been any recent constipation?
Yes
No
Explain further if needed
Does your pet ever strain to urinate?
Yes
No
Explain further if needed
Has your pet been coughing?
Yes
No
Explain further if needed
Has your pet been sneezing?
Yes
No
Explain further if needed
Has your pet been lethargic?
Yes
No
Explain further if needed
Any weakness or stiffness?
Yes
No
Explain further if needed
Any lameness?
Yes
No
Explain further if needed
If so, check which leg:
RF
LF
RR
LR
Shaking of head?
Yes
No
Explain further if needed
Any scratching? Where?
Yes
No
Explain further if needed
Has there been significant hair loss?
Yes
No
Explain further if needed
Does your pet scoot on his/her rear?
Yes
No
Explain further if needed
New or unusual lumps or bumps?
Yes
No
Explain further if needed
Any behavioral changes?
Yes
No
Explain further if needed
Bad breath?
Yes
No
Explain further if needed
Other
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