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Medical History Questionnaire

Today's Date:

Patient and Client Information


History of Current Problem

Has your pet received any previous treatments for the primary problem?

What medications or treatments is your pet currently receiving?

Nausea/Vomiting

Coughing/Sneezing

Pain/Discomfort


Past Medical History

Most recent vaccines

Does your pet like to hide?

If yes, please describe:

ls your pet comfortable in a kennel?

If no or sometimes, please explain:

Does your pet like to chew on things?

If yes, please describe:


Client Care Record​​​​​​​

Would you like text or phone call updates of your pet while in our care?

Would you like pictures updates of your pet while in our care?

Would you like extra information about your pet's care team?

Would you like to be discharged in the lobby, over the phone, or a private room?

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