Pre-Visit Survey for Dogs Fill out this questionnaire before each preventive care visit to help us be as thorough as possible during your appointment.Dog's Name*Your Name* . Is your dog microchipped with up-to-date registration? Yes No Unsure Are you interested in microchipping your dog during your visit? Yes No Please tell us about your pet’s diet, including any treats, dental chews, or human foods.Your dog's body condition is: Overweight Ideal Underweight Unsure Which parasite preventative(s) is your dog receiving? Simparica Trio Bravecto Milbeguard Interceptor Nexgard Heartgard Plus Seresto Over-the-counter spot-on None Other If you selected other, please specify below.How often is your dog receiving the parasite preventative(s)?Please tell us about all other prescription or OTC medications, supplements, nutraceuticals, herbs your pet is receiving, including current dose and frequency.Preventive lab testing is an important way for us to detect potential health issues before your dog shows symptoms at home. If your dog's lab testing is normal, we obtain a baseline of lab values while your dog is healthy. This allows us to track them over your dog's lifetime and intervene when they deviate from what's normal for your dog.Are you interested in preventive lab testing for your dog? Yes Maybe No What type of home dental care does your dog receive?Please check any of the following that apply: my dog lives with other animals my dog lives with children my dog visits dog parks my dog goes to grooming/boarding facilities Will your dog be traveling with you outside of this region? If so, please list where you will be traveling.Other regions may have a higher risk for certain diseases that may be preventable (i.e. lyme disease or canine influenza).If your dog has had any behavior changes since his or her last visit, please describe them here.If your dog is having any mobility or comfort issues, please describe them here.If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.Any special requests?If you need a vaccine certificate for proof of vaccination after your visit, please log in to your Online Portal.CAPTCHA
