Patient History Questionnaire | The Pet Doctors of Sherman Oaks Skip to Main Content Skip to Footer

CAREERS | Pet Portal

Hours 13756 Ventura Blvd Suite 101
Sherman Oaks, CA 91423

Patient History Questionnaire

Patient Name*

Appointment Date/Time*

Is there anything in particular that you would like the doctor to address during your pets visit?

Is your pet experiencing any problems with coughing / sneezing / vomiting / diarrhea?

Are there any changes in your pets urination / defecation habits?

Are there any changes with your pets thirst / hunger levels?

Are there any changes with your pets activity level?

What are you currently feeding your pet?

How much do you feed your pet?

How often?

Is your pet on flea/tick preventative? If so, what is the brand?

How often is it administered?

When was the last dose?

Is your pet taking heartworm prevention? If so, what is the brand?

How often is it administered?

When was the last dose?

Is your pet on any medications or supplements other than the above flea / heartworm preventives?

Please list current medications and current dose

How much time does your pet spend outside each day?

Does your pet have any travel history outside of Los Angeles/the Valley?

Would you like to have bloodwork performed during your pets visit?

Yes

No

Will you be bringing a fecal sample?

Yes

No

Additional comments or questions below

Additional comments or questions below

patient history questionnaire

The Pet Doctors of Sherman Oaks