Sick Pet Appointment Form

Full Name*

Primary Phone Number*

Pet's Name*

Have something you want to show us? Add it here!

When did your pet start experiencing symptoms?

What exactly are you seeing at home? *

If your pet is having diarrhea, approximate how many times per day:

Describe the diarrhea (large puddles, small droplets, blood in it, any mucous, etc):

Stool Quality Score*

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

If your pet is vomiting, approximate how many times per day:

Describe the vomit (large puddles, small foamy vomit, blood in it, etc):

Have you brought a stool sample today?*

Yes
No

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

What diet is your pet currently eating?*

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

How long has your pet been on this diet?*

What table scraps/homemade cooking or treats does your pet get?*

When was the last bag of food opened?*

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

Does your pet have possible access to the compost/garbage/recycling?*

Yes
No

Security Question*

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