Email (This should be the main email you would like us to use for your account) (required)
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Dog's Name (required)
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Owner's Name (That account is under in our system) (required)
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Who will be bringing your dog to their appointment?
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What is the best contact number for that person during the appointment time?
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Is this a cell phone that can accept text message reminders from us?
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Has your dog shown any of the following signs or symptoms? If no, leave blank. If yes, please explain. |
Coughing, gagging, or wheezing?
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Vomiting, Diarrhea or Scooting on rear end?
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Red gums, offensive breath, excessive drooling, or sensitivity while chewing?
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Lameness or difficulty when getting up?
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Lethargy, listlessness or anxiety (hiding or uncontrollable shaking)?
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Unusual body odors, itching, scratching, poor hair coat, hair loss, skin problems or ear odor/head shaking?
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Lumps or bumps?
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Has your dog shown a significant change in any of the following? If no, leave blank. If yes, please explain. |
Change in appetite or increase in drinking?
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Weight gain or loss?
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Change in behavior, training or behavioral issues?
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Difficulty in Hearing or with Vision?
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ENVIRONMENTAL EXPOSURES AND TESTING |
Is your dog primarily:
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Tick Exposure Level:
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Mosquito Exposure Level:
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We recommend YEARLY testing for the following diseases:
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- Heartworm Disease: Contracted by a single mosquito bite, fatal in not detected, symptoms take 1-2 years to develop
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- Lyme Disease: Contracted by a Deer Tick bite. Most common infectious disease we see in dogs! Most cases can be treated with antibiotics, rarely it can lead to severe and fatal complications
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- Anaplasma: Similar in many ways to Lyme Disease, except symptoms can be very vague, chronic, or recurrent
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Routine Screening Tests: I would like:
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PREVENTATIVE PRODUCTS- Would you like us to dispense any of the following today? |
Flea / Tick Prevention:
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Heartworm / Intestinal Parasite Prevention
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Other |
Would you like your dog's nails trimmed today? (There is a fee for this)
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Do you have any other questions or comments about your dog today?
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Senior Screening / Preventative Wellness Bloodwork Screening |
When your pet is in for it's Annual Wellness Exam
We also offer the opportunity to have us perform some basic lab screening tests at a significant discount to ensure that your pets organs and metabolic functions are all working well.
These tests are even more important if your pet is: |
- Over 7 years old
- Will need general anesthesia for a surgical or dental procedure in the coming months |
- Has any chronic medical conditions
- Receives regular medications for a chronic problem |
Are you interested in Preventative Wellness Screening for your dog today?
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