New Puppy/Kitten Pre-Exam Questionnaire

Name: Somerset Animal Hospital
Address: 715 Rivard St., Somerset, WI, 54025, United States
Telephone: 715-247-2324
Price range: $

Thank you for choosing Somerset Animal Hospital! Please fill out the new puppy/kitten questionnaire below.

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New Puppy/Kitten Questionnaire

Please fill out this form as completely and accurately as possible so we can get to know your pet(s) information before your visit. Please note this form is not to be used for emergency appointments. If you have an emergency please call the Animal Emergency and Referral Center at 651-501-3766.

Owner/Primary Contact *

First

Last

Email *

Pet's Name *

Appointment Date *

Species *

When did you bring your new Puppy or Kitten home? *

Do you have pet insurance? *

Yes
No
I woud like more information

If yes, what company? *

Please visit our Pet Insurance page for more information!

Do you have any concerns you would like address during your visit and when did they start?

Are you aware of any previous medical conditions and/or diagnosis note from breeder or prior owner?

Where will your pet live: *

Indoors most of the time
Indoor/Outdoor
Outdoor only

Do you plan for your pet to be a Hunter? *

If yes, what will they hunt?

Have you noticed any vomiting or diarrhea since you picked up your pet? *

Do they seem to be eating and drinking normally, and with out issue? *

What type/brand of food do you currently feed your pet? *

Is it grain free? *

What is the protein source? *

Chicken
Beef
Other

If other, please list *

Typically, how much, and how many times a day, do you feed your pet? *

Have you started any type of Flea and Tick or Heartworm prevention for your puppy or kitten? *

If yes, what brand? *

When was it given? *

Has your new pet been dewormed that you know of? *

If yes, when? *

What was given? *

Do you plan on doing any type of training with your puppy? *

Check all that apply:

Puppy classes or basic obedience
Hunting
Service or Therapy Animal (Non-ESA)
Other

If other, please list

Are you/do you plan on kennel training? *

(Although many dog owners may feel guilty for crate training their canine companion, enclosed spaces create a shelter for your dog to rest and relax. In fact, dogs instinctively seek small spaces to create protective shelters for themselves. Crates are useful training tools for puppies, safe havens for senior dogs, and lifesavers for emergencies. Why Crate Training is Great for Your Dog)

Do you plan on taking your new pet to:

Dog park or Other Pet Gatherings
Boarding or Doggy Daycare
Grooming

Please bring with to your visit (Puppies and Kittens): 1) Any paperwork or records you got with your new puppy or kitten 2) A fresh fecal sample (A fecal test allows our veterinarians to check your pet for intestinal parasites, which may live in your pet’s gastrointestinal tract. Since they are usually hidden from view, the only way to detect the presence of most intestinal parasites and identify them is by doing a fecal test. We recommend a basic fecal panel to be checked annually. This can be dropped off at any time during business hours or brought with during your next visit. Sample should be collected right away and brought in same day.)

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Address

715 Rivard St.
Somerset, WI 54025

Contact

P: 715-247-2324
F: 715-706-6100
E: Smallpets54025@gmail.com

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Hours

Mon - Fri: 8:30AM-5:30PM

Sat & Sun: Closed

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First

Last

Email *

Phone

How can we help you? *

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