Client Name:* First Last Dog(s) Name:* Date and time of appointment:* How long have you had them?* Where did you get him/her?* Are they spayed/neutered?* Have they been to any vet that we do not have records for? Please contact any previous vet care providers to request records be emailed or faxed to PVS before your appointment.* Do they have any chronic health issues?* Are they eating, drinking, urinating and defecating normally?* What kind of food are you feeding? How much, how many times a day? How long has he/she been on this diet?Have they been coughing, sneezing, vomiting or had diarrhea?* Are they on any medications or supplements, flea/tick/heartworm or other parasite prevention products?* Do they have a history of reactions to vaccines or medications?* What is their lifestyle like? Do they participate in breeding or showing? Are they indoor only or indoor/outdoor?*Do they travel outside of Maine? If so, where?* What questions or concerns would you like to discuss with the doctor?*We recommend checking for intestinal parasites at your pet’s annual wellness exam or with any GI symptoms. If you would like to do this, please bring a fresh fecal sample to the appointment. We recommend a comprehensive health screening to assess general health and check for any underlying disease. Many chronic diseases can be detected before symptoms are apparent, improving treatment and management options.