Puppy Visit Exam Questionnaire

Our puppy exams focus on preventive care, nutrition, behavior, and vaccinations to give your puppy the best start possible. This questionnaire helps us learn more about your puppy’s daily routine, health, and environment so we can provide personalized recommendations.

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About This Form

By completing this Puppy Visit Exam Questionnaire, you provide our veterinary team with valuable background information that helps us assess your puppy’s health, address any concerns, and create a tailored care plan.

Client Information

Owner's Name *

First

Last

Phone Number *

Please enter a valid phone number.

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Information

Pet’s Name *

Pet’s Date of Birth

What is your pet here for today? *

How is your pet’s appetite? *

How is your pet’s water intake? *

Any changes in your pet’s urination? *

Does your pet have any abnormal licking or scratching? *

What brand of food do you feed your pet? *

How much does your pet get (½ cup, 1 can) and how often? *

How is your pet’s energy level? *

Has your pet ever had a reaction to vaccines? *

Does your pet visit any of the following? *

Has your puppy started any obedience training? *

Medications

Is your pet on any medications? *

Include Heartworm and Flea Prevention

Phone

Puppy Visit Exam Questionnaire

About This Form

Client Information

Pet Information

Medications

Ready for a Visit?

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Location

Hours