Name *

First

Last

Email *

Pet's Name *

Has your pet been eating normally? *

What type and brand of food and treats does your pet eat? *

What table food or scraps does your pet get? *

Does your pet have bad breath or trouble with his/her teeth? *

What do you use for home dental care? *

Has there been any vomiting or soft stool? *

Have you noticed any changes in drinking or urinary habits? *

Has your pet been having trouble with stiffness, a limp, or getting up after lying down? *

Has your pet’s activity level changed? *

Are there any lumps for us to check at this appointment? *

If yes, where are they and are they new? *

What heartworm preventative and flea/tick preventative are you giving to your pet? *

How many months of the year do you give heartworm and flea/tick preventative? *

What medication or supplements is/are your pet currently on? (Drug Name, Strength, Frequency) *

(For Cats Only) How much time does your cat spend outdoors?

Will you need any refills of medication while you are here for your pet’s appointment? *

Is there anything else we should know about your pet’s health? *

If yes, please specify *

Do you have pet insurance? *

Who is your pet insurance carrier? *

If none, would you like information on pet health insurance? *

Wellness Appointment Questionnaire

Ready for a visit?