Canine Medical History Questionnaire Form

Save time during your appointment. Complete your canine medical history questionnaire form online from any device before your visit.

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Canine Medical History Questionnaire Form

Please fill out this form as completely and accurately as possible so we can get to
know you and your pets before your visit.

You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Please bring the completed PDF form for your pet’s first appointment.

DOWNLOAD FORM

Thank you for choosing Gulfshore Animal Hospital’s exceptional veterinary care for your pet. So that we may get to know your pet better prior to your appointment with one of our doctors, please complete our following Medical History Questionnaire.

Your Name: *

Email *

Your Pet’s Name: *

Nickname? *

Your Pet’s Diet:

Dry Brand(s): *

How Much? *

Cups

How Often? *

times daily

Canned/Moist Brand(s): *

How Much? *

Can/Packet

How Often? *

Times Daily

Fresh/Frozen Brands(s): *

How Much? *

Tablespoons/Packet/Inches(circle one)

How Often? *

Times Daily

Treat Brands(s): *

How Many? *

How Often? *

Times Daily

Chew Things (rawhide, hard rubber, real bones, etc): *

Times Daily

Your Pet’s Exercise (Check any that apply):

Number of years in your household. *

Total number of dogs in household. *

Total number of cats in household. *

Indoors only, never goes outside, uses Wee-Wee Pads or some other “indoor potty”. *

Indoors mainly, only goes outside for short walks “to do our potty business”. *

How often does your pet exercise in a fenced or electronically fenced yard, and what activities do they enjoy? *

How long is your pet leash walked for? *

How many minutes is your pet leash walked for? *

How many miles is your pet leash walked for? *

How many times each day is your pet leash walked for? *

Your Pet’s Hygiene (Check any that apply):

How often does your pet bathe? *

How many times per week does your pet bathe? *

How often do you use (Brand) shampoo on your pet when bathing them? *

How frequently is your pet professionally groomed, and why every (number of) weeks? *

Your Pet’s Current Medications: