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Canine Annual Physical Questionnaire

Thank you for taking the time to answer these questions. This will help our Veterinarians understand your dog's diet, lifestyle, and environment.

Name*
First Last
Pet's Name*
Is your dog on any medications or supplements?*
- Yes
- No
If on medications and supplements, please list.
Appetite*
Food Type*
Food Brand*
Diet Frequency*
Water Consumption*
Activity Level*
Do you have any other pets in your home? If so, please list:*
Do you board your dog or go to a grooming facility, obedience school, leash free parks or pet shows?*
Does your dog travel with you to destination vacation places (cottage, out of province, USA, etc.):*
If they do travel with you, please indicate where:
Does your dog hunt?*
If your dog does hunt, does (s)he eat their prey?
Does your dog vomit?*
Does your dog persistently cough?*
Does your dog persistently sneeze?*
Does your dog persistently itch?*
If your dog does itch, please indicate the location(s) on their body:
Has your dog experienced any mobility issues?*
If lameness has been noticed, please state which leg(s) and the duration.
Have any fleas or ticks been noticed recently?*
Do you apply flea prevention?*
Do you give heart worm prevention?*
Do you get skunks, raccoons, or rodents in your yard or neighbourhood?*
Does your dog have access to rivers, lakes or ponds?*
Have you noticed any lumps you would like to have checked? If so, please include their approximate locations on body:*
Our clinic is 'Fear Free' and the veterinarians and team take into account not only your pet's physical well-being, but also their emotional well-being.
During past veterinary visits, what level would you classify your pet as on the Spectrum of FAS (Fear, Anxiety and Stress)?*
Should you have any additional concerns, please include them here:
Lastly, please describe which number best describes your pet's stool?**
Thank you for your time in helping us understand your pet better. Together we can continue to preserve that special bond!