Name *
Pet's Name *
Email *
What are your pet's major health concerns at this time? *
When did your pet last visit your regular veterinarian? What is the name of the clinic and may we exchange medical records with them? *
Does your pet have any known allergies to food, supplements, or medications?
Is your pet on any medications? If so, please give the name, strength, dosage, how long they have been on the medication and when they started the medication. (ie. amoxicillin, 250 mg tablet, 1 tablet every 12 hours, 14 day treatment started July 1, 2021) *
What diet are you feeding your pet at this time? Please provide the type(s) of food, brand name, amount you are giving and how often you are giving it to your pet. *
Does your pet have any excessive or unusual coughing, sneezing, vomiting or diarrhea? If so, please describe what you are seeing, how often it is happening and how long it has been happening for. *
Is your pet’s appetite and thirst normal, increased or decreased? If increased or decreased, can you estimate how much it has changed *
Is your pet able to stand and walk normally? How is their energy level? Please describe if there are any changes or concerns. *
Is your pet able to eliminate normally and in the area they are supposed to? Is there any incontinence, constipation, or other elimination concerns?
Do your pets' routines and behaviours seem normal and consistent? Do they seem happy and content? If abnormal, please describe.
Does your pet’s cognition seem normal? Do they respond to people, other pets or things that interest them like they have done before? Do they seem confused, disoriented, or anxious at times?
Does your pet seem comfortable? Do they still enjoy going on walks, being petted or groomed as they used to? Can they still jump to the bed, couch or go to other favorite areas as they used to? Are they sleeping comfortably or are there any indications or restlessness, pain or discomfort?
Does your pet seem to breathe normally and comfortably? Are they breathing faster, slower or with more effort than they used to?
Do you feel your pet has a good quality of life? if not, what are your main concerns?
Is your pet friendly with strangers, shy or possibly aggressive? If there are any concerns, please describe and let us know how we can better help your pet. *
Is there any additional information you would like to share with us?