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Dog Questionnaire for Wellness Examination

For the annual wellness examination, we want to know all about the care and treatment your pet gets at home as this information is an important part of your pet’s health history. To help save time at the check-in desk, please complete this form online prior to your pet’s annual wellness exam appointment.

Fields marked with an * are required

 

Annual Questionnaire For Dog Wellness Exam

 

Medications

Please list all supplements/medications along with dosage and frequency given. (Please be aware that all chronic medications will require bi-annual testing.)
Please enter none if no medications are given.  

 

Have you noticed any changes in the following?

 

Preventative Care:

Please write none if no preventative medications are used.

Please write none if no preventative medications are used.

 

Current Diet

 

Additional Information