Annual Physical Exam and Vaccinations Form PhoneThis field is for validation purposes and should be left unchanged.Client Name* First Last Patient Name*Patient Gender* Male Female Neutered Male Spayed Female Patient Age*MedicationsIs your pet currently on any medications?Is your pet on a flea/tick/heartworm during the warmer months? Yes No Product name:Date of last dose given:Does your pet travel to warmer climates with you during the winter months? Yes No Fecal ExamAlthough less common in adult pets, intestinal parasites can pose a health risk to both your pet and your family. We recommend checking a sample yearly. Did you bring a sample of your pet’s stool with you today? Yes No Would you like to prepay for a fecal exam today? (you will be given a container that can be used to drop off a sample later) Yes No DietThe single biggest decision you will make every day as a pet owner is ‘What you put in the bowl” Commercial pet foods vary widely in their quality, nutritional value, and consistency. Feeding the appropriate quantity is also important to maintain your pet at a healthy weight. What brand of food are you currently feeding your pet?How much?How many meals/day?Do you feed your pet tablefood? Yes No Percentage of diet?Please list any additional treats and or supplementsOn a scale of 1-9 (with 1 being extremely under weight, 5 being ideal weight and 9 being extremely overweight) what number would you give your pet?MyVetStore.caSault Ste. Marie Animal Clinic has an online store MyVetStore.ca (https://www2.myvetstore.ca/) where you can purchase high quality food and treats for your pet and have it delivered directly to your door. There are many manufacturer discounts and incentives and purchases can be automated or as needed.Would you like more information about MyVetStore.ca? Yes No Would you like diet recommendations or advice about feeding your pet Yes No LifestyleDoes your dog go to Groomer Boarding Kennel Dog Park Bellvue Park/Boardwalk Dog Shows Obedience/Agility We recommend an annual Kennel Cough vaccination for all ‘Social Dogs’ that have contact with other dogs of unknown vaccination status. Would you like your dog vaccinated for Kennel Cough? Yes No I would like more information Does your dog frequently go hunting or hiking with you? Yes No If so, where?Does your cat go outside? Regularly Occasionally Rarely Never Does your cat hunt small rodents and birds? Yes No For cats that go outside, even on occasion, we recommend vaccination against Feline Leukemia Virus. If your cat has never had this vaccine before they should have a blood test done first. Please let us know if you would like more information.Senior Wellness ScreenFor pets 7 years of age and over, we recommend a yearly blood test (+/- urine) to check their internal organs. Many age-related conditions such as kidney disease can be slowed and/or managed with early diagnosis and interventions such as feeding a specific diet.Would you like a Senior Wellness Blood Screen for your pet today? Yes No Since your pet's last visit have you noticed any of the following?For each option, if yes, please explain. If no, please leave blank.Eye problemEar problemSkin problemMouth/dental problem/bad breath/difficulty eatingCheck new or changing lump or bumpCoughing/sneezing/difficulty breathingVomiting and/or diarrhea Any blood noted?Changes in bowel habits (constipation, diarrhea, accidents)Changes in urine habits (Urinating more/less/accidents)Change in appetite (eating more/less/not eating)Limping/lamenessStiffness/soreness/difficulty getting aroundDrinking more or lessWeight gain or lossBehaviour change (depressed, restless, hiding/lethargic)OtherPlease send us any photo you think we may find informative ( #1 )Max. file size: 2 GB. Please send us any photo you think we may find informative ( #2 )Max. file size: 2 GB. Please send us any photo you think we may find informative ( #3 )Max. file size: 2 GB. Is there any additional information you would like to add or other concerns you would like to discuss??
