Home
About Us
Our Story
Staff
FAQs
BLOG
Services
Specialty and Advanced Care
Sports Medicine & Rehab
Specialty Surgery
Preventative Care & Wellness
For Clients
Testimonials
Contact
GUNDOGdoc
Clinic Hours: 605-334-2412 • After Hours Emergency: 605-977-6200
Home
About Us
Our Story
Staff
FAQs
BLOG
Services
Specialty and Advanced Care
Sports Medicine & Rehab
Specialty Surgery
Preventative Care & Wellness
For Clients
Testimonials
Contact
GUNDOGdoc
Client History
Owner #1 Name
*
Owner #2 Name
Pet Name
*
How long have you owned your pet?
*
Where did you obtain your pet?
*
Did your pet have any major problems as a puppy or kitten?
*
Yes
No
If 'Yes', please briefly explain.
When was s/he last vaccinated?
*
Which vaccines were included?
Does your pet take heartworm prevention?
*
Yes
No
If 'Yes', which one?
Does your pet receive flea or tick control?
*
Yes
No
If 'Yes', which one?
Do you have other pets?
*
Yes
No
If 'Yes', what types?
What does your pet routinely eat?
Do you provide any treats or snacks?
*
Yes
No
If 'Yes', what types?
Where does your pet live?
*
Indoors
Outdoors
Both
Has your pet traveled?
*
Yes
No
If 'Yes', where?
Has your pet been spayed or neutered?
*
Yes
No
If 'Yes', when?
If a female, did she have a heat cycle prior to her spay?
Yes
No
Has your pet ever had surgery?
*
Yes
No
If 'Yes', what for?
Has your pet ever been hospitalized?
*
Yes
No
If 'Yes', what for?
Has your pet experienced any adverse reactions to foods or medications?
*
Yes
No
If 'Yes' what kind of food or medication? What happend?
Are you able to give your pet liquid medications?
*
Yes
No
Pills?
*
Yes
No
Please note if your pet has experienced any of the following:
Cough
Difficulty Breathing
Ocular Discharge
Increased Appetite
Weight Gain
Vomiting
Change in Stool Color
Lameness
Seizures
Confusion
Itching
Bruising
Any Masses
Sneeze
Fast Breathing
Nasal Discharge
Decreased Appetite
Weight Loss
Diarrhea
Pain Anywhere
Change in Activity
Fainting
Change in Behavior
Loss of Hair
Change in Skin Color
Please List All Current Medications
Contact Us
Name
*
Email
*
Message
*
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3209 S. Summit Ave
Sioux Falls, SD 57105
P:
605.334.2412
E:
After Hours Emergency:
605-977-6200
