Patient History Questionnaire Please completely fill out the Patient History Questionnaire form prior to your appointment. Name *FirstLastEmail *Any concerns or questions you would like to address at your pet’s upcoming appointment?What is your pet eating? (Select all that apply)Dry food(s)Wet food(s)Treats/snacksWhat brand of dry food, flavor and quantity?What brand of wet food, flavor and quantity?What brand of treats, flavor and quantity?How is your pet’s appetite?Does your pet have any chew toys? If so, what are they?How much water is your pet drinking per day?What heartworm preventative is your pet on? Year round?What tick preventative is your pet on? Year round?What other medications is your pet on (name, dose, frequency)?Any coughing, sneezing, diarrhea or vomiting? If yes to any, please describe character and duration. How much exercise is your pet getting a day?How’s your pet’s energy level?Does your pet go for walks? On leash or off leash?Does your pet go anywhere for boarding, grooming or day care?Any travel history outside of New England?Is there any prior medical history?NameSubmit
