COMPREHENSIVE PET HISTORY
Feline
Felv
□
Fvcrp □
Rv
□
Combo □
Aws
□
Sws
□
Fecal □
Indoor □
Outdoor □
Chief complaint or reason for visit? _____________________________________
□Yes □ No
□Yes □No
Has your pet been seen for the same condition lately?
Does your pet have a history of having seizures?
If yes, how long ago? _________________
Is your pet currently on any medications?
Is your pet allergic to any drugs/medications?
□Yes □ No
□Yes □ No
Has your pet’s stool been evaluated for internal parasites
within past 6 months?
□Yes □No
Diet: _______________________ how many times a day do you feed your pet? ___________
Is your pet on heartworm prevention?
If yes, which one? _____________________________
Is your pet on flea control?
If yes, which one? _____________________________
□Yes □No
□Yes □No
Oral Cavity/Teeth
Are you brushing your pet’s teeth at home?
Has your pet had a professional dental cleaning?
Bad Breath?
□Yes □No
□Yes □No
□Yes □No
Nose/Throat
□Yes □No
□Yes □No
Coughing?
Sneezing?
Dermatology
Scratching?
□Yes □No
Significant hair loss?
□Yes □No
If yes, describe? _______________________________________________________________________
Urinary/Genital
Urination?
□ Decreased
□ Normal
Straining to Urinate?
Unusual discharge?
□ Increased
□ Increased freq.
□Yes □No
□Yes □No
Gastrointestinal
Bowel movements abnormal?
If no, describe?__________________________________
Vomiting
□Yes □No
□Yes □No
Musculosketal
Lameness ?
□Yes □No
If yes, describe?
______________________________________________________________________________________
Behavior
Scooting?
Any listlessness?
□Yes □No
□Yes □No
Any additional questions you have for us during your appointment?
______________________________________________________________________________________
______________________________________________________________________________________