Animal Doctor Blue Hills Your Other Family Doctor GI ISSUES First name * Last name * Preferred contact number. * Patient name * NEW PATIENTS ONLY: How long have you had the patient? NEW PATIENTS ONLY: Where did you get him/her? NEW PATIENTS ONLY: Is the patient microchipped? Yes No Unsure NEW PATIENTS ONLY: Vaccination history (be specific) NEW PATIENTS ONLY: Does the patient have any underlying conditions? Yes No Unsure NEW PATIENTS ONLY: If yes, please explain. IF YOUR PET IS VOMITING: How long have you noticed the vomiting? What does the vomit look like? IF YOUR PET IS VOMITING: How often does your pet vomit? And does it occur at a particular time? IF YOUR PET IS VOMITING: Are they still eating? If they are still eating, do they eat fast? Can they keep anything down including water? IF YOUR PET IS VOMITING: Has this happened in the past? Yes No IF YOUR PET HAS DIARRHEA: How long have you noticed the diarrhea? What does it look like? Straining to Defecate? IF YOUR PET HAS DIARRHEA: Has your pet experienced increased frequency or accidents in the house? Yes No IF YOUR PET HAS DIARRHEA: Has your pet experienced recent stress or boarding? Yes No IF YOUR PET HAS DIARRHEA: Has your pet been lethargic? Yes No What kind of food are you feeding? Any recent change in food or new bag? * Could they have ingested something abnormal? * Is your pet current on vaccines? * Yes No Have you tried anything at home? Please explain if yes. * Is the patient on any medications? Include dosage and frequency. * Are you administering flea/ tick preventative? What type and how often? * Are you administering heartworm preventative? What type and how often? * Do we have permission to perform fecal testing, bloodwork, or any additional diagnostics? * Yes No Unsure Do you have any additional questions or concerns you would like to address with the Doctor today? * If you are human, leave this field blank. Submit
