MyVet Home Veterinary Service

drsandra@myvetvancouver.ca
North Vancouver, BC V7R4J3

(604)786-1641

myvetvancouver.ca

We are doing our best to prepare for your pet's wellness visit!  In order to help us do so, please provide us these details in advance.  Simply take 5 or 10 minutes to complete this form, and submit to us.  The more we know, the better we can help you help your pet not only survive, but thrive for years to come....

Wellness Consultation: Pre-Visit

Your pet's name (required)
First Name (required)
Last Name (required)
What form of diet do you feed your pet? Please check all that apply. (required)
Dry food
Canned food
Raw diet
Home cooked diet
other
Exactly how much do you feed your pet per day? (Please be as specific as you can) (required)

What brand of food(s) do you feed your pet? (required)

Are you giving regular medications or supplements? Please specify (required)

Have you noticed any of the following more than once per month? (check all that apply)
Vomitting
Diarrhea or soft stools
Constipation or Problems passing stools
Blood in Stools
Picky Appetite or Inappetance
Increasing water consumption or urine volume
Lethargy or lack of Energy
Coughing
Sneezing
Itchy skin
Fleas
Ticks
Limping or decreasing ability to run, jump, rise, climb stairs
Stiffness when walking
Weight loss
Weight gain
If you have checked any boxes above, please provide any further detail you are able

Outdoor access/contact with other pets or animals- please check all that apply
Indoor exclusively
Patio access
Outdoors under supervision only
Visits off-leash or leash-optional pet areas
Able to Roam Free outdoors unsupervised
Hunts
Attends pet daycare
Visits groomer regularly
In the past 12 months have you travelled to any of the following locations with your pet?
United States
Okanagan
Ontario
International
other
Dental care/strategies for your pet : please check all you use regularly
Oral cleansing wipes, brushing, dental spray
Prescription dental care diet
Dental treats
Optimized water consumption
Professional dental cleanings as necessary
other
Routine flea, tick and worm control for your pet: please check all that apply
Revolution for Fleas and Worms
Sentinel tablets for Fleas and Worms
Bravecto tablets for Ticks and Fleas
Program injections (cats only) for fleas only
Advantage for fleas only
Deworming tablets
other
Would you like access to our online pet store for free delivery of your pet's diet/supplements/meds? (required)
Yes
No
Do you need us to bring any of your pet's medications, supplements or food when we visit you?


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