Pre-Appointment Patient History – Cottage Country Animal Clinic

Pet Name

First

Species

Breed

Birthday

Sex

Colour

Spayed or neutered

Reason for the Visit - Concern

How long has this been going on for?

Current food/treats/anything recently changed or something that the pet may have eaten that's new?

Appetite

Water intake?

Change in urination habits?

Change in bowel movements?

Medications or supplements, and if yes, please list

Coughing/Sneezing

Vomiting/Diarrhea

Recent environmental changes?

Behaviour patterns (lethargic/normal/hyperactive)?

Any other questions/concerns?