Summary of Patient’s Health for Exam

Pet’s Name

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Phone Number

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What kind of food are you feeding, including treats? How much?

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Is heartworm prevention medication up to date or have there been any missed doses?

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Has there been any previous vaccine reactions or reactions to other medications? Are you hoping to have specific vaccinations administered today?

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How many bowel movements a day?

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How many episodes of urination a day?

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Is your pet eating and drinking well (or has there been any increase in water intake, any changes in how they are eating)?

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Any itching/scratching?

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Any limping/stiffness?

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Any lumps noticed?

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Any recent or noticeable weight loss?

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Any behavioural problems/concerns?

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