Vomiting / Diarrhea Fill out this questionnaire before your medical problem visit to help us be as thorough as possible during your appointment.Your Pet's Name* Your Pet is a:* Dog Cat Your Name* First Last Preferred Email Address* 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 Please list all medications and supplements your pet receives. Please include when the last dose was given. Please list the current dose and frequency given.*Please describe your pet's diet, including treats. Please describe the amount, frequency, and brand/type.*Are there any changes or differences in environment / housemates / schedule at home? If so, please explain below.*Is your pet vomiting?* Yes No If yes, when did it start and how often? Is your pet having normal bowel movements?* Yes No If no- please describe color, consistency, frequencyAre your pet’s activity levels normal, higher than normal or lower than normal?* Higher Than Normal Lower Than Normal The Same Is your pet still trying to eat and/or drink?* Yes No Did your pet receive any human foods, get new/abnormal treats, take any medications not prescribed for them, chew on households items or have access to anything in the yard in the past 2 weeks?* Yes No Are any other pets in the household showing similar symptoms?* Yes No Has your pet been to the dog park, boarding, or been exposed to pets that are not in the household?* Yes No Are there any other concerns you are seeing at home?*
