Pet History Form Client Name*Pet Name*Appointment Date & Time*Select reason for visit*WellSick / InjuryPlease answer the following questions regarding your pet’s visitBrand of diet fedIs it grain free?Amount per dayWhat types of treats are given?Is your pet taking ANY medications or supplements? If yes, please list the medication name and frequency:Please list when it started, how often and if this is a new or ongoing illnessCoughingVomitingLimpingLumps or bumpsSneezingDiarrheaItchinessIncreased or decreased thirstIncreased, decreased or frequent urinationIs your pet currently taking a monthly heartworm preventative? Type? Last dose given?Is your pet currently taking a monthly flea and tick preventative? Type? Last dose given?PhoneThis field is for validation purposes and should be left unchanged.