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 todayClients First & Last Name* First Last Pet being seen today*Please select the nature of your pets visit today? (Select all those that apply)* Examination Visit with Vaccines – all vaccination appointments receive a full physical exam before vaccines are given Comprehension Examination Visit – there is a medical concern or questions I have relating to my pets health Wellness Examination Visit – there are no medical concerns today for my pet, I wish to have wellness physical exam preformed on my pet todayPlease select all that apply. I am concerned about the following items for my pet today:* Change in eating habits Change in drinking habits Coughing Sneezing Vomiting Change in bowel movements Diarrhea Change in urination habits Change in attitude or activity levelPlease 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?*Diarrhea: first noticed, and frequency?*Please explain the change in urination habits*Please explain the change in urination habits*Please explain the change in attitude or activity level*Lifestyle QuestionsThe following questions are related to the lifestyle and everyday care you provide to your petList 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*Frequency taken*Add another medication?* Yes NoName & strength of medication*Frequency taken*Add a third medication?* Yes NoName & strength of medication*Frequency taken*Add a fourth medication?* Yes NoName & strength of medication*Frequency taken*Add a fifth medication?* Yes NoName & strength of medication*Frequency taken*Please select the following items your pet engages in and activities you do with your pet in:* dog park grooming visits Third Choice hiking camping swims in lakes, ponds and rivers swims in poolsLast time your pet has engaged in the activities listed above?*Please list other questions or concerns you would like the doctor to address today*CAPTCHA