K9 Annual in Oakland, CA | The Grand Lake Veterinary Hospital

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Your First Name*

Your Last Name*

Pet's Name*

Appointment Date*

Any vomiting, diarrhea, coughing, or sneezing?*

How has your pet's energy level been? Any lethargy?*

Have there been any changes in water consumption?*

Have there been any changes in urination habits?*

Have there been any changes in eating habits or appetite?*

Have there been any changes in defecation?*

What brand of food do you feed your pet?*

Type of Food?*

Wet
Dry

What Heartworm Preventative does your dog take?*

if other, please specify*

Date Last Given Heartworm Preventative*

Does your dog do any of the following?*

What flea and tick preventative do you use?*

if other, please specify*

Date Last Given Heartworm Preventative*

Would you like any refills at your appointment? If so, what?*

Do you have any other concerns you'd like to discuss?*

Your veterinarian will discuss vaccines with you, if appropriate, but do you want any additional services today (anal gland expression, nail trim, etc.)?*