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New Pet Questionnaire
Pet Name_____________________________________________
Age_________ Breed________________ Species Dog Cat Other
Sex: Male Intact Female Intact Male Neutered Female Spayed
Color: ________________________________________________________
Where did you get the pet?
Breeder Shelter Friend Rescue Org. Found as Stray Other
How Long Have You Had the Pet?________________________________
Environment Indoor Only Mostly Indoor w/ some yard Yard Only Roams Free
Circle all that apply: Within the next year, I plan to take my pet to a/an:
Boarding facility Grooming facility Dog park Obedience/ training class
General Health
Appetite Ravenous Good Fair Poor
Stool Firm Normal Loose Diarrhea
Urination Very frequent Normal Decreased None
Water Consumption Excessive Normal Decreased None
Vomiting? Yes No If Yes, How Often? _____________________
Coughing? Yes No If Yes, How Often? _____________________
Sneezing? Yes No If Yes, How Often? _____________________
Blood or mucus in stool? Yes No
Previous Vaccines? YES NO
If yes, what clinic?_____________________________________________________________
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