Pet's Name * Is your dog on any medications or supplements? * 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: * Our clinic is 'Fear Free' and the veterinarians and team take into account not only your pet's physical well-being, but also their emotional well-being. 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 using the Fecal Scoring Chart? * 1 2 3 4 5 6 7 Thank you for your time in helping us understand your pet better. Together we can continue to preserve that special bond!