Emergency/Alternate Phone Spouse/Partner Spouse/Partner Phone Pet #1 Name Pet #1 Species Pet #1 Breed Pet #1 Color Pet #1 Age/Birthday Is your pet on any medications? Medication Name How much medication are they given? How often is the medication given? Brand of food given? How many times per day are they fed? And, how much are they fed AT EACH feeding? How much food is given per feeding? How many times a day are they fed? What heartworm preventative do you give your pet? Do you have another pet to add? Which pet(s) is this appointment for? Please select any canine vaccines your pet will be needing: Please select any feline vaccines your pet will be needing: Any other services needed? Please indicate any medical concerns or changes in behaviors you’ve noticed since their last exam. What other concerns or issues do you want to make sure the Doctor addresses, examines or discusses with you during the exam? Please indicate below all medications your pet is currently taking, this includes prescribed medications, supplements, preventatives as well as over the counter products. Please include Name of Medication, Dosage, Frequency, Last Dose Given, Purpose of Medication. YOU WILL NEED TO COMPLETE THE MEDICATION AUTHORIZATION FORM as well for these medications. That form is on our website and a link was/will be provided in an email and/or text message from the Pet Resort. What prescription refills will your pet need during their visit? Is this a new pet for your family? What kind of treats, snacks, table scraps and/or chews do you give your pet? Does your pet have any sensitivities (activities, situations, or areas on the body)? Has your pet ever bitten anyone or other dogs? Has your pet ever shown anxieties when visiting the Veterinarian? Would you be interested in your pet receiving obedience training services? Please indicate if your pet will be exposed to any of the following: Will your pet primarily be inside or outside? How much of their time will be spent outdoors? (Please indicate time spent outside, i.e. two hours, most of the day, just for potty breaks) Indicate the activity level that best suits your pet: What dental care do you provide your pet at home: Has your pet been seen by another Veterinarian or been to the Emergency Hospital since your last visit? Are you receiving regular service reminders for your pet’s medical services? We are now offering Wellness Plans, are you interested in learning more about our Wellness Plans? For some of our Medical Progress Exams we offer Telemedicine visits with the Veterinarian. This service offers “FaceTime” or video chat with the Veterinarian, would you be interested in learning about that service?