Patient Medical History Questionnaire Please answer the following questions about your pet’s medical history. Use a separate History Questionnaire for each pet. Attach any previous medical records you may have or submit the Medical Records Release form to have your pet’s records transferred to our hospital.Client Information* First Name Last Name Pet's Name:* Reason for today’s visit/presenting health concern? How long have you owned this pet?* Where did you obtain this pet?* Have you recently traveled with your pet?* Is your pet on HEARTWORM prevention? What kind?* Is you pet on FLEA/TICK prevention? What kind?* Has your pet been exposed to fleas or ticks?* Is your pet indoor, outdoor, or both?* Is your pet used for hunting or taken hunting trips?* Any prior illnesses?* Is your pet used for breeding? Last date of breeding/heat cycle?* Any non-elective surgeries?* Has your pet ever had an allergic reaction to vaccinations?* Does your pet eat anything besides dog or cat food?* Please list any medications your pet is currently taking:* ANY ADDITIONAL COMMENTS OR CONCERNS:*
