Vaccine Appointment

Your First Name:

Your Last Name:

Email:

Your Pet's Name:

Has your pet ever had any vaccine reactions? These may include vomiting/diarrhea/facial swelling/lethargy/pain. Please list.

Have you noted any vomiting or diarrhea lately *If yes- How often/how frequent/what color?

Any excessive coughing/sneezing? *If yes-Any coloured discharge from eyes or nose?

Any lumps/bumps? *If yes-How long have they been there/have they grown/any bleeding

Any scratching or chewing on themselves anywhere (ears or on body)

How is his/her appetite? What diet are you feeding & how much? (include human foods) *If they have any vomiting or diarrhea has s/he received any new foods or treats lately?

How is his/her water consumption? Have you noted that his/her drinking increased or decreased? Explain

Any concern with his/her urination habits i.e. more/less? *If it’s a cat-is s/he using the litterbox? Any accidents outside of the box?

If cat goes outside: how frequently does s/he go outside?

If cat hunts- how frequently does s/he hunt?

Is your pet on any current medications? Please list if they were not prescribed here.

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