(802) 879 6311
129 Main St, Essex Junction, Vermont 05452
Hit enter to search or ESC to close
Home
New Clients
About
Meet Our Team
Take A Tour
Promotions
Careers
Services
Anesthesia and Patient Monitoring
Exotic Pet Medicine and Surgery
Health Certificates
Laser Therapy
Medical Services
Nutritional Counseling
Preventive Services
Surgical Services
Veterinary Dentistry
Wellness and Vaccination Programs
Additional Services
Pet Health
Pet Health Checker
Pet Health Library
Pet Food Recalls
Pet Insurance
Product Recalls
How-To Videos
News
Pet Portal
Pet Records
Refill Requests
Mobile App
Online Pharmacy
Contact
Pet Health Questionnaire
Please note, this form is to be used for scheduled appointments only
Pet Health Questionnaire
Pet's Name
*
Client's Name
*
Phone
(if curbside)
Has your pet had any of the following? Please check all that apply;
*
Coughing
Sneezing
Vomiting
Diarrhea
Increased Drinking
Increased urination
None of these
Please Describe (What is it like? When did it start?):
Have you noticed any changes in behavior or activity level?
*
Are there any new lumps or bumps you’ve noticed and would like examined today?
*
Have you noticed any lameness, soreness, or stiffness?
*
What are you currently feeding? (Brand, Quantity, Treats, etc)
*
Are there any medications or supplements you give? If so - how much and how often?
*
Do you use flea and tick medication? If so what brand? Seasonally or year round?
*
Do you use Heartworm preventative? If so what brand? Seasonally or year round?
*
Did you need to pick up any medications today?
*
If yes, please list.
Are there any issues/concerns you would like addressed today?
*
If your pet is due for vaccinations within the next month, would you like those given today?
*
Yes
No
Are you interested in running wellness bloodwork today if recommended?
*
Yes
No
DOGS: If your dog is due for their Heartworm and tickborne disease test, may we run it?
*
Yes
No
CATS: Does your cat go outside at all?
*
Yes
No
N/A
Home
New Clients
About
Meet Our Team
Take A Tour
Promotions
Careers
Services
Anesthesia and Patient Monitoring
Exotic Pet Medicine and Surgery
Health Certificates
Laser Therapy
Medical Services
Nutritional Counseling
Preventive Services
Surgical Services
Veterinary Dentistry
Wellness and Vaccination Programs
Additional Services
Pet Health
Pet Health Checker
Pet Health Library
Pet Food Recalls
Pet Insurance
Product Recalls
How-To Videos
News
Pet Portal
Pet Records
Refill Requests
Mobile App
Online Pharmacy
Contact
Pet Health Questionnaire
