When is your pet's appointment?* Date Format: MM slash DD slash YYYY What time is your appointment?* : HH MM AM PM What is the reason for your pet’s visit?*When were your pet’s last vaccines given?* Date Format: MM slash DD slash YYYY Does your pet interact with others (ie park, boarding, dog park, etc)?*YesNoIs your pet on flea/tick/heartworm prevention?*YesNoWhat is the brand and when was their last dose given?*What diet do you feed your pet? How much and how often do you feed them?*Is your pet primarily indoor or outdoor or equally both?*IndoorOutdoorBothDoes your pet participate in outdoor activities (ie walks, hikes, swimming, etc)?*YesNoDo you have other pets in the household?*YesNoWhat kind?*If your pet’s visit is for sickness or discomfort, please answer the following questions:Is your pet experiencing coughing/sneezing/vomiting/diarrhea?* Coughing Sneezing Vomiting Diarrhea Please describe when it started by date, if it is consistent or intermittent.*Is the food digested?*YesNoAre there any foreign items in the vomit?*YesNoWhat is the consistency of the vomit?*How frequently are they vomiting?*Could they have eaten something inappropriate?*YesNoHave you recently changed their diet?*YesNoDoes the content of the vomitus include food or bile (yellowish frothy saliva)?*YesNoIs there blood?*YesNoPlease describe*How frequently is this occurring?*Is there any blood or mucus in the stool?*YesNoDescribe the consistency of the stool.*When did the coughing start?*How often do they cough?*Describe the cough? Dry/hacking, productive, high pitch wheeze*Did the patient lose consciousness before, during or after the cough?*YesNoFor how long?*When did the sneezing start?*Is the sneezing constant or intermittent?*ConstantIntermittentIs there any nasal discharge?*YesNoDoes your pet spend any time outside unattended?*YesNoIs your urinating as he/she normally does?*YesNoWhen did it start?*Is the change daily?*YesNoHas the urine production increased or decreased?*IncreasedDecreasedWhen was the last time they produced urine?*Is there any straining?*YesNoDo they ever posture and not produce any urine?*YesNoAny change in appetite or water intake?*YesNoIncrease or decrease in appetite? Will your pet still eat treats? When did it start?*Increase or decrease in water intake? When did it start?*Have you seen any behavior changes?*YesNoDescribe the change.*Eliminating in the house? Having to go out to eliminate more often?*YesNoNo longer sleeping through the night/sleeping pattern changed?*YesNoSeems depressed or has become more active?*YesNoANY sign of aggression?*YesNoPlease describe*Are there any changes in their environment?*YesNoAre they taking any prescribed medication?*YesNoPlease list with strength and instructions of medication(s).*Are they taking any over-the-counter medications?*YesNoHas the patient had any medical treatment and or surgery in another hospital?*YesNoPlease list so we can contact them for medical records.*