PART I: MEDICAL HISTORY

 

General Medical History:

Yes No
Yes No
Yes No

Current Health Problem(s):

Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Clumsiness Limping Difficulty turning Inability to walk on slippery surfaces Scissoring gait/crossover Falling when turning quickly
Licking Chewing Whining Sluggishness Restlessness Flinching Trembling Stumbling (esp. w/fatigue)
Yes No
Yes No
Yes No
Yes No
Right Left Unknown
Right Left Unknown
Yes No
In the house Outside
Yes No
Yes No
Yes No

PART II: SOCIAL HISTORY

Yes No
Eager to please Afraid of strangers Active Nervous/temperamental Lethargic Aloof Shy
Companion Agility Flyball Working dog Obedience trails Field trails Hunting coursing Tracking Therapy
Yes No

PART III: HABITS

Swimming Playing w/tennis balls Daily walks (how far) Weekend athlete
Yes No
Yes No
Separation anxiety Marking Biting/nipping when certain body parts are touched Bolting through open doors Jumping up Fear or dislike of water Grabbing food treats aggressively
Food Treats Bones Toys
People Other dogs
Yes No

Thank you for your cooperation in completing this information. Your assistance allows us to provide a comprehensive treatment plan, involves you in the care planning, and individualizes the care for the unique needs of your animal companion.

I Agree

ISN'T IT TIME FOR YOUR DOG TO FEEL LIKE A DOG AGAIN?