Pre-Visit Survey for Dogs Fill out this questionnaire before each preventive care visit to help us be as thorough as possible during your appointment.Dog's Name* Your Name* . Preferred E-mail Preferred Phone Number Is this number a cell phone? Yes No Which method(s) of communication do you prefer? Text Messaging Phone Call E-mail Is your dog micro-chipped with up-to-date registration? Yes No Unsure Please tell us about your pet’s diet, including any treats, dental chews, or human foods. Your dog's body condition is: Overweight Ideal Underweight Unsure Which parasite preventative(s) is your dog receiving? Simparica Trio Bravecto Milbeguard Interceptor Nexgard Heartgard Plus Seresto Over-the-counter spot-on None Other If you selected other, please specify below. How often is your dog receiving the parasite preventative(s)? Please tell us about all other prescription or OTC medications, supplements, nutraceuticals, herbs your pet is receiving, including current dose and frequency.Preventive blood screening is an important way for us to spot potential health issues before your dog shows symptoms. It also allows us to obtain a baseline of blood values while your dog is healthy.Are you interested in adding on a wellness blood screen to your dog's visit? Yes Maybe No What type of home dental care does your dog receive? Please check any of the following that apply: my dog lives with other animals my dog lives with children my dog visits dog parks my dog goes to grooming/boarding facilities If your dog goes to grooming/boarding facilities, where should we send a vaccination certificate? Will your dog be traveling with you outside of this region? If so, please list where you will be traveling. Other regions may have a higher risk for certain diseases that may be preventable (i.e. lyme disease or canine influenza).If your dog has had any behavior changes since his or her last visit, please describe them here.If your dog is having any mobility or comfort issues, please describe them here.If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.CAPTCHA
