Pet History Form Name* First Last Pet's Name Reason for appointment:* Wellness Care Injury or Illness Do you have any specific concerns about your pet? Yes No Please describe your concerns.How is your pet eating? What is their current diet? How much do they eat daily?Have they been urinating normally? Yes No Does your pet have normal drinking? Yes No Please explain*Has there been any vomiting? Yes No If yes, please describe.Has there been any diarrhea?* Yes No If yes, please describe.*Has there been any coughing? Yes No If yes, please describe.*Has there been any itchiness or other skin concerns? Yes No If yes, please describe.*Have you noticed any new skin lumps or have concerns about previously examined skin lumps?* Yes No If yes, please describe which lumps and where they are on your pet.Have you noticed any signs of pain or poor mobility? Yes No Please describe.*Have you noticed any changes in energy or exercise tolerance? Yes No Please describe changes.*Have you noticed any changes in behavior? Yes No Please describe any changes in behavior.*Does your pet take any supplements? Yes No Please list the supplements they are taking.* Does your pet take any medications? Yes No If yes, please list the medications they are taking, and doses if possible.*NameDosage Do you need any refills on any of your pet’s medications or supplements today? Yes No Refills Have you traveled anywhere recently with your pet? Yes No Where have you traveled?* Please list anything else you would like to address while you and your pet are here today.