Pet's Name *
If on medications and supplements, please list.
Appetite * Excellent Good Picky Poor
Food Type * Kibble Kibble & Canned Canned Only Raw
Food Brand *
Diet Frequency * Once Daily Twice Daily Three Times Daily Free Fed
Water Consumption * Drinks normal amount Drinks excessive amount Doesn't drink a lot
Activity Level * Normal High energy Sedentary
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? * No Yes
Does your dog travel with you to destination vacation places (cottage, out of province, USA, etc.): * No Yes
If they do travel with you, please indicate where:
Does your dog hunt? * No Yes
If your dog does hunt, does (s)he eat their prey? No Yes
Does your dog vomit? * My dog does not vomit My dog vomits occasionally My dog vomits excessively
Does your dog persistently cough? * My dog does not cough My dog coughs occasionally My dog coughs excessively
Does your dog persistently sneeze? * My dog does not sneeze My dog sneezes occasionally My dog sneezes excessively
Does your dog persistently itch? * No Seasonally Year Round
If your dog does itch, please indicate the location(s) on their body:
Has your dog experienced any mobility issues? * No Yes On Occasion
If lameness has been noticed, please state which leg(s) and the duration.
Have any fleas or ticks been noticed recently? * No Yes
Do you give your dog parasite prevention? * Yes No
Do you get skunks, raccoons, or rodents in your yard or neighbourhood? * Yes No
Does your dog have access to rivers, lakes or ponds? * Yes No
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)? * FAS 0 FAS 0-1 FAS 1 FAS 2 FAS 3 FAS 4 FAS 5
Should you have any additional concerns, please include them here:
Lastly, please describe which number best describes your pet's stool? * 1 2 3 4 5 6 7