Animal Doctor Westside Your Other Family Doctor COUGHING/SNEEZING 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. Is your pet: * Coughing Sneezing Both How long have you noticed the coughing and/or sneezing? * Briefly describe the cough. For example: dry, hacking, wet? How often does he/she cough and/or sneeze? Is it worse during a particular time of the day? * If coughing, is the cough productive? i.e. phlegm Any discharge from the eyes or nose? Color? * How is your pet's appetite, thirst, and urination? * Has your pet been in contact with other animals? * CATS ONLY: How often does your cat go outside? Does he/she go outside on a leash or on a screened in porch? Is your pet experiencing (check all that apply): * Vomiting Diarrhea Lethargy None of the above Have you tried anything at home? * What kind of food are you feeding? How much per day? Table scraps/ treats? * Is the patient on any medications? Include dosage and frequency. * Are you administering heartworm preventative? What type and how often? * Are you administering flea/ tick preventative? What type and how often? * Do you have any additional questions or concerns you would like to address with the Doctor today? * Submit If you are human, leave this field blank.