Pre-visit history form

Current main diet (including brand and flavour) *

Amount fed and frequency *

Is it a grain free (ie does not contain rice, barley, oats, wheat) diet that has peas/lentils/legumes listed within the first ten ingredients? *

Yes No

If You answered 'Yes' to the above, please consider checking out this information LINK. We are happy to discuss in greater detail at your appointment!

Vomiting *

Yes- Lots Yes- Rarely No

Diarrhea *

Yes- Lots Yes- Rarely No

Coughing *

Yes- Lots Yes- Rarely No

Sneezing *

Yes- Lots Yes- Rarely No

Discharge eyes or nose *

Yes- Lots Yes- Rarely No

Collapse *

Yes No

Seizures *

Yes No

Lump(s) *

Yes- New Yes- Old No

Limping or troubles getting around *

Yes- Lots Yes- Sometimes No

Pain *

Yes No

Incontinence or inappropriate urination/defecation *

Yes- Lots Yes- Rarely No

Itching and licking- please score out of 10 (0= no itching, 10= never stops) *

Please elaborate on any identified concerns (eg when it started, frequency of issue, if it is worsening or staying the same etc) *

We would like to keep your pet as calm as possible. What can we do to help make them comfortable? (eg. favourite treats, approaching, tips for handling) *