Pet History Form

Patient Name:

1. Any previous history of medical disease?

2. Is your pet on specific medications?

3. Has there been a history of poisons, medications (pet or people medications) or toxin that your pet could have gotten into?

4. Are there any types of poisonous plant, insects, or animals your pet could have come in contact with?

5. Is there any chance of physical trauma?

6. Has your pet had a history of Coughing / Sneezing / Vomiting / Diarrhea / Increased Thirst / Increased Urination?

7. Has your pet shown any signs of collapse, weakness or a decreased ability to exercise?

8. Has your pet shown any abnormal neurological behavior? (Example: Seizures, Twitching, Falling Over, Dragging Limbs...)

9. Does your pet like to eat abnormal things? (Rocks, Sticks, Socks...)

10. Does your pet have any travel history out of the state?

11. Are there other animals within the household and how is their health?

12. Are your pet’s vaccinations and annual diagnostics (Heartworm Testing, FELV/ FIV, Fecal Exams) up to date?

13. What is your pet’s normal diet and are they fed “people food”?

14. Other important information we should know?

Send photos of what medication of what the client pets ate, or paperwork health:

Max. file size: 5 GB.

Contact Info

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