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3843 Soules Road Severn, Ontario L3V 0V3
Phone: (705) 326-4800
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Pre-Appointment Questionnaire
Pre-Appointment Health Questionnaire
Please enter your first and last name
*
Please enter your pets name
*
Please list your concerns for this appointment
*
Has your pet had any vomiting recently?
*
Yes
No
Has your pet had any diarrhea recently?
*
Yes
No
Has your pet had any Changes in the passing of urine or stool recently?
*
Yes
No
Has your pet had any changes in thirst or drinking recently?
*
Yes
No
Does your pet have a new or worsening cough?
*
Yes
No
Does your pet have new or increased sneezing?
*
Yes
No
Has your pet had any changes to their eating recently?
*
Yes
No
Has your pet experienced a seizure?
*
Yes
No
Does your pet have any new lumps or bumps?
*
Yes
No
Symptoms Explanation
If you answered yes to any of the above questions please provide a brief description of what your pet has experienced.
Please list your pets regular diet and also what type of treats they receive
*
Medications/Supplements given
Is your pet currently taking any medications/supplements? If so please list the name of the product, how much is given and how frequently
Please describe your pets typical environment (indoors only, fenced yard, etc.) and daily activities
*
Does your pet visit the boarding kennel, dog groomer or dog park?
*
Yes
No
Would you like your dog to receive the Bordetella Vaccine today?
*
Yes
No
I would like to discuss this further
Not applicable
Does your dog walk off leash in wooded areas?
*
Yes
No
Not applicable
Would you like your dog to receive the Leptospirosis Vaccine today?
*
Yes
No
I would like to discuss this further
Not applicable
Does your cat go outdoors unsupervised or hunt?
*
Yes
No
Not applicable
Would you like your cat to receive the Feline Leukemia Vaccine today?
*
Yes
No
I would like to discuss this further
Not applicable
Does your pet travel outside of their home city?
*
Yes
No
Does your pet go swimming?
*
Yes
No
Do you have any leftover Flea/Tick/Heartworm prevention from last season?
*
Yes
No
Are you wanting to pick up any Flea/Tick/Heartworm Prevention or Dewormer during your visit?
*
Yes
No
Do you have any other pets in the house/environment?
*
Yes
No
If you answered yes to the above question please list all of other pets in the home.
Do you have any other questions/concerns that you would like the team to be aware of prior to your appointment?
About Us
Contact
Our Veterinarians
Our Careteam
Feedback Survey
Blog
New Clients
What to Expect
Take A Tour
Make an Appointment
Forms
Services
Wellness
Diagnostics
Surgery
Dental
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Product Recalls
Pet Food Recalls
News
Links
Contact Us
Make Appointment
Shop Now