Pre-Visit Survey for Puppies Fill out this questionnaire before your puppy's initial visit to help us be as thorough as possible during your appointment.Puppy'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 What is your puppy's date of birth? MM slash DD slash YYYY If date of birth is unknown, please give approximate age. Where and when was your puppy acquired?* If you are aware of any medical or behavioral issues with your puppy's parents or litter-mates, please list them below.Is your puppy micro-chipped with up-to-date registration? Yes No Unsure Please tell us about your puppy's diet, including either treats or human foods. Has your puppy started heartworm/intestinal worm prevention? If so please select which product from the list below. Simparica Trio Selarid None Other If you selected other, please list the product here. Has your puppy started flea & tick prevention? If so please select which product from the list below. Bravecto Nexgard Selarid Credelio None Other If you selected other, please list the product here. Please list all other prescription or OTC medications, supplements, nutraceuticals, herbs.My puppy lives with or will visit:* other animals children person with suppressed immune system (i.e. chemotherapy) grooming/boarding facilities If you selected other animals, please explain below. If you selected grooming/boarding facilities, where should a vaccination certificate be sent? Please tell us about your puppy’s exercise routines, mental stimulation/enrichment activities, and socialization.Please let us know what questions and concerns you have about your puppy’s care, behavior, or veterinary needs.
