Animal Doctor Westside Your Other Family Doctor LIMPING/LAMENESS 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. How long have you noticed the limping/lameness? * Which leg(s) are affected? * Front left Front right Rear left Rear right How often does he/she limp? Is it worse at a particular time of the day? * Does your pet have any history of trauma? * Yes No Please explain if yes. 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 abnormal appetite, thirst, or urination? Check any abnormalities. * Appetite Thirst Urination None of the above Any limping in the past? Please explain if yes. * Have you tried anything at home? Please explain if yes. * Is the patient on any medications? Include dosage and frequency. * What kind of food are you feeding? How much per day? Table scraps/ treats? * 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 radiographs, 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? * Submit If you are human, leave this field blank.