Canine Pre – Examination Form - Ahwatukee Commons Veterinary Hospital

To better serve you during our COVID 19 curbside service we have a pre-questionnaire we ask that you fill out before your pet’s physical exam time. By answering this questionnaire fully prior to your visit, we hope to reduce your wait time and minimize stress for you and your pet.

Please answer the following questions to the best of your abilities. Once completed please email back to customercare@theacvh.com. Your veterinary technician will review the questionnaire before your arrival and will further discuss your pet needs on the phone at the time of your pets’ appointment. If you are bringing more than 1 pet to be seen today we ask that each pet has their own form filled out before their appointment time today

Pet being seen today*

Please explain the change in eating habits*

Please explain the change in drinking habits*

Coughing: first noticed & frequency?*

Sneezing: first noticed & frequency?*

Vomiting: first noticed & frequency?*

Please explain change in bowel movements*

Diarrhea: first noticed, and frequency?*

Please explain the change in urination habits*

Please explain the change in attitude or activity level*

Lifestyle Questions

The following questions are related to the lifestyle and everyday care you provide to your pet

List the brands of food being fed, this includes canned food.*

How much of the food is being offered and how many times a day?*

List the brands/types of treats including how many in a day? These include all items fed not listed above.*

List all medications, including over the counter medications, and supplements (both topical and oral) below.

Name & strength of medication*

Last time your pet has engaged in the activities listed above?*

Please list other questions or concerns you would like the doctor to address today*

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Lifestyle Questions

See what we can do for you today!

See what we can do
for you today!