Sick Patient Questionnaire

*PLEASE BRING A STOOL SAMPLE TO YOUR PET'S APPOINTMENT IF POSSIBLE. WE WILL SEND IT FOR A FECAL TEST AS MONTHLY DEWORMERS DO NOT PREVENT COCCIDIA OR GIARDIA*

*PLEASE BRING A FRESH URINE SAMPLE TO YOUR PET'S APPOINTMENT OR DROP OFF SOONER IF POSSIBLE. PLEASE REFRIGERATE AND/OR BRING SAMPLE IN WITHIN 0-4 HOURS OF COLLECTION.

IF THERE IS NO CONCERN OF ACUTE INFECTION, WE MAY ASK FOR A FIRST MORNING URINE SAMPLE, COLLECTED BEFORE EATING BREAKFAST, IN A CLEAN PLASTIC CONTAINER WASHED AND RINSED WELL THE NIGHT BEFORE AND AIR DRIED OVERNIGHT.

PLEASE DO NOT WITHHOLD YOUR PET'S WATER UNLESS SPECIFICALLY ASKED TO DO SO.

PLEASE REFRIGERATE SAMPLE AND/OR BRING TO CLINIC WITHIN 0-4 HOURS OF COLLECTION.*

COUGING *

Visits groomers or dogs parks Does pet produce honking sound? Vomiting after coughing Coughing when exercising Coughing when lying down or at night History of heart disease If heart disease, is there exercise intolerance? If heart disease, have x-rays or ultrasound been performed, if new to us? If heart disease, is your pet currently on heart medications, if new to us?

*PART OF A COMPLETE EYE EXAM MAY INCLUDE TESTING FOR TEAR PRODUCTION, CHECKING EYE PRESSURES AND STAINING THE EYE TO CHECK FOR ULCERS BEFORE DISPENSING MEDICATION. THE VETERINARIAN WILL CALL YOU BEFORE PERFORMING THESE TESTS IF THEY FEEL THEY ARE NECESSARY*

Sick Pet History

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