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Veterinary Medical Center of Spring – Present History Form

Client: ______________  Pet: __________           Date:________

PET’S DIET:   

SPECIFIC OR FREE CHOICE:  

SNACKS OR TABLE FOOD  :

CHANGES IN APPETITE:

CHANGES IN DRINKING:

CHANGES IN URINATION:

CHANGES IN DEFECATION:

ANY VOMITING:: 

ANY COUGHING OR SNEEZING: 

DISCHARGE FROM EYES OR NOSE: 

SCRATCHING, LICKING, OR CHEWING:

LUMPS OR BUMPS:

ANY LIMPING OR JOINT PROBLEMS:

ANY CHANGE IN BEHAVIOR:

ITCHY SCALE: 

CONTACT WITH OTHER PETS AT GROOMER, PARKS, TRAVELING: 

FLEAS OR TICKS NOTED:

  FLEA PREVENTION USED/WHAT KIND:

HEARTWORM PREVENTION:

ANY MEDICATIONS:

BATHE PET:

  PRODUCT USED:

PREVENTATIVE DENTAL CARE IF ANY:  

HAS YOUR PET EVER BECOME SICK AFTER A VACCINATION?

OTHER INFORMATION: