Pre-Appointment Questionnaire

Name*

First Last

Email*

Phone*

Pet Name*

Reason for Appointment*

My pet is ill
General examination and vaccines
Pre-op spay/neuter examination
Nail trim
Behavioural concerns
other (please describe below)

Do you have any health concerns with your pet?*

Yes
No

If YES, please describe.

Are there any current or past medical conditions we should be aware of?*

Yes
No

If YES, please describe.

Have you noticed any change in your pet's activity or energy?*

Yes
No

If YES, please describe.

What is your pet's regular diet? Has there been any changes in appetite? Please list any known food allergies.*

Please provide details below. What brand(s) of food do you feed your pet? Is it wet/dry food? 1 cup or can/day?

Are we authorized to give treats during the examination?*

This may include freeze-dried liver treats, squeeze cheeze or peanut butter.

Yes
No

Has there been any vomiting or diarrhea?*

Yes
No

If YES, please be as detailed as possible. Here are some factors to consider. Does your pet eat inappropriate, non-food objects? Has your pet has a recent diet change? Are there any plants your pet could have eaten? What does the vomit or diarrhea look like? Bile, food, blood or foreign material? How long have they had this condition? When was the last vomit/diarrhea?

Is your pet coughing or sneezing?*

Yes
No

If YES, please describe.

We're looking for details such as how often, is there anything (ie. foam, green/yellow phlem) coming up, how long have they been coughing or sneezing (ie hours/days), are there any new scents/litter/dust in the house and if there's any other circumstance that you believe may have caused it.

Have you noticed any change in your pet's water intake?*

Yes
No

If YES, please describe.

Have you noticed any change in your pet's frequency, amount and/or location of urination?*

Yes
No

If YES, please describe.

Have you noticed any increased scratching or licking?*

Yes
No

If YES, please describe.

Does your pet have any allergies or drug reactions?*

Yes
No

If YES, please list below.

Is your pet currently on any prescription medications or supplements?*

Yes
No

If YES, please list below.

Do you have any behavioural concerns with your pet?*

Yes
No

If YES, please describe. **IMPORTANT** Let us know if your pet is intolerant to any type of handling or treatment. If they've experienced any type of aggression during a previous visit to a veterinarian, please indicate below.

FOR NEW PETS: How long have you had your pet and where did you acquire him/her?

FOR CAT OWNERS: Is your cat an outdoor cat?

Yes
No

If YES, please describe when and where your cat travels.

FOR DOG OWNERS: Do you travel outside of the city with your dogs?

Yes
No

If YES, please describe (e.g. cottage country, Prince Edward County, Ottawa, USA)*

The prevalence of ticks in southern Ontario is increasing yearly.

Pre-Appointment Questionnaire

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