Schedule An Office Visit | Dogwood Veterinary Hospital

Client Name*

First

Last
What symptoms are you observing?*
When did you first notice these symptoms?*
What diet is your pet currently eating and how much?*
What heartworm/flea/tick prevention is your pet currently taking?*
When was the last dose given?

MM slash DD slash YYYY
How many doses do you have left?*
Have you found any ticks on your pet recently?*
Any change in urination or defecation habits?*
Any change in food or water intake?*
Is your pet up to date on his/ her vaccinations?*
When was the last time you pet had a dental cleaning?*
Would you be interested in an injectable heartworm preventative that provides 6 months of coverage?*
Where do you prefer to purchase your preventatives?*
*It is always best if you can collect and bring a fecal sample with you to your pet’s appointment.

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