New Client Appointment Form

Pet's Name

Species (Cat/Dog/Other)

Breed

Colour

When is your pet's birthday?

*It's OK if you don't know the exact date

What sex is your pet?

What is the name of the clinic where your pet was last examined?

If this file could be under someone else's name, please let us know!

Does your pet have any known allergies?

What changes have you noticed in your pet’s personality or behaviors?*

Please rate your pet's itchiness*

Score from 1-10, 1 being not itchy at all, 10 being extremely itchy

Stool Quality Score*

Score from 1-5, 1 being profuse diarrhea, 5 being extremely hard

Does your pet... (your opinion)*

Drink too much water
Drink the right amount of water
Not drink enough water

Is your pet peeing more than usual?*

Yes
No

Have there been any recent accidents in the house?*

Yes
No

Does your pet attend grooming/boarding/daycare/dog park facilities?*

Yes
No

Does your pet hunt?*

Yes
No

Does your pet roam freely outdoors?*

Yes
No

Does your pet eat feces/drinks outdoor water from wildlife/other pets/its own?*

Yes
No

Do you camp with your pet?*

Yes
No

Was your pet living in or traveling with you to heartworm/tick endemic area in the last 12 months? (USA, Southwest/Northern Ontario)?*

Yes
No

Was your pet on heartworm prevention last summer from June until November?*

Yes
No

When was the last dose of flea/tick and or heartworm prevention given?

Does your pet have a history of vaccination reaction?*

Yes
No

What diet is your pet currently eating?*

Please note canned and dry food

Please upload pictures of any food, treats, medications or supplements your pet is currently taking:

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New Client Appointment Form

PET #1 DETAILS

PET #2 DETAILS

APPOINTMENT DETAILS

New Client Appointment Form

PET #1 DETAILS

PET #2 DETAILS

APPOINTMENT DETAILS

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