Canine Annual Physical Questionnaire

Thank you for taking the time to answer these questions. This will help our Veterinarians understand your dog’s diet, lifestyle, and environment.

Name *

First

Last

Pet's Name *

Is your dog on any medications or supplements? *

If on medications and supplements, please list.

Appetite *

Food Type *

Food Brand *

Diet Frequency *

Water Consumption *

Activity Level *

Do you have any other pets in your home? If so, please list: *

Do you board your dog or go to a grooming facility, obedience school, leash free parks or pet shows? *

Does your dog travel with you to destination vacation places (cottage, out of province, USA, etc.): *

If they do travel with you, please indicate where:

Does your dog hunt? *

If your dog does hunt, does (s)he eat their prey?

Does your dog vomit? *

Does your dog persistently cough? *

Does your dog persistently sneeze? *

Does your dog persistently itch? *

If your dog does itch, please indicate the location(s) on their body:

Has your dog experienced any mobility issues? *

If lameness has been noticed, please state which leg(s) and the duration.

Have any fleas or ticks been noticed recently? *

Do you give your dog parasite prevention? *

Do you get skunks, raccoons, or rodents in your yard or neighbourhood? *

Does your dog have access to rivers, lakes or ponds? *

Have you noticed any lumps you would like to have checked? If so, please include their approximate locations on body: *

During past veterinary visits, what level would you classify your pet as on the Spectrum of FAS (Fear, Anxiety and Stress)? *

Should you have any additional concerns, please include them here:

Lastly, please describe which number best describes your pet's stool using the Fecal Scoring Chart? *

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