Phone * Secondary Phone Email * Secondary person authorized to make decisions about your pet's healthcare: Please include their phone number here: Pet's Name * Breed * Age/Date of Birth * Does your pet have a microchip identification? * When and where did you get your pet? * Does your pet have any previously diagnosed health conditions? If so, what? * Please list any previous veterinary hospitals your pet has visited so we may obtain records. Reason for leaving? * Please list any other household pets, if applicable. * Do you feed your pet canned food, dry food, or both? * What medications, supplements, or human products is your pet on? * Please list name, strength, and frequency of the medications your pet is receiving. Brand name of pet’s food and the main protein (ie. chicken, beef, fish, etc.): * How much do you feed your pet? * Does your pet have any known drug sensitivities or allergies? * Does your pet go outside (cats only)? * Is your pet on a monthly parasite/flea/tick preventative? * Have you traveled or plan to travel with your pet in the next 12 months? If so, where? * Have there been any changes in your pet’s appetite (i.e. increased or decreased)? * Have there been any changes to your pet’s defecation (i.e., increased or decreased frequency, soft or hard stools, straining, vocalizing, blood, etc.)? * Will you / did you bring a fecal sample for us to screen for intestinal parasites? * Have there been any changes to your pet’s drinking (i.e., increased or decreased)? * Have there been any changes to your pet’s urination (i.e., increased or decreased frequency, straining, vocalizing, blood, etc.)? * Have there been any changes to your pet’s energy level? * Has your pet recently lost or gained weight? * Is your pet coughing, sneezing, and/or having nasal or eye discharge? * Have you noticed your pet having any difficulty breathing? * Does your pet seem itchy (i.e., scratching, licking paws, head shaking)? * Have you noticed any limping? * Does your pet have any new lumps or bumps? * Do you provide dental care for your pet? * Does your pet have health insurance? * Has your pet shown any aggression toward people or other animals? * Can we post photos of your pet on social media? * We love to give our patients high-value treats such as peanut butter to enforce positive associations with their visits. If you or someone in your family has food allergies, please list them below. Please attach any previous medical records or information you like to share.