Pre-visit history form

Sooke Veterinary Hospital

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In order to smooth your upcoming visit at Sooke Veterinary Hospital, please complete the below form prior to your arrival. This will allow our doctors to focus on your concerns regarding your pet's health, while still ensuring all pertinent information is gathered for your case.

Pre-visit history form

* Indicates required field

Pet Name *

First

Last

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Confirm email address *

Appetite *

Current main diet (including brand and flavour) *

Amount fed and frequency *

Is it a grain free 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!

Most recent date and brand of flea or tick control *

Current medications and/or supplements *

Drinking *

Energy *

Concerns (please tick yes/no for each)

Vomiting *

Yes No

Diarrhea *

Yes No

Coughing *

Yes No

Sneezing *

Yes No

Discharge eyes or nose *

Yes No

Incontinence or inappropriate urination/defecation *

Yes No

Seizures *

Yes No

Collapse *

Yes No

Limping or troubles getting around *

Yes No

Itchiness *

Yes No

Lump(s) *

Yes No

Pain *

Yes No

Other concerns (please list) *

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

Any additional information you wish us to know? *

Are you or any members of your household ill with COVID-19 symptoms? *

Yes No

Are you or a member in your household currently under quarantine or awaiting a COVID-19 test? *

Yes No

Submit

If you are ill, we ask you delay presenting your pet (if possible) or send your pet with an agent.