Wellness Exam Questionnaire

Wellness Exam Questionnaire

Please answer all questions, prior to the appointment date, to the best of your ability. If you are unsure or have questions, please mark “Unsure” or “Unknown”.

Is your pet microchipped?



If your pet is new to us, please provide a birthdate or approximate age.

Medical Concerns: Please check each symptom, that applies to your pet, below.
















Lifestyle: What would you say best describes your pets lifestyle?



Please check any extracurricular activities that your pet participates in:










Has your pet had any previous vaccine reaction(s)? (i.e. vomiting, diarrhea, lethargy, soreness, swelling, or hives)