Client Name:*

First Last

Pet(s) Name:*

Date and time of appointment:*

Please describe the problem you have noticed, and which leg you think is bothering them.*

How long have you noticed the symptoms?*

Is there a known history of trauma?*

Is this the first time this issue has occurred?*

Is it shifting leg lameness, or is one leg affected?*

Is there a change in activity?*

Are they eating, drinking, and urinating 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 sneezing, vomiting or had diarrhea?*

Are they on any medications or supplements?*

Do they have a history of reactions to vaccines or medications?*

For dogs: What is their lifestyle like? Does he/she participate in breeding, working, hunting, canine sports or obedience classes, daycare, boarding or grooming?*

For cats: What is their lifestyle like? Does he/she participate in breeding or showing, is he/she indoor only or indoor/outdoor?*

Do they travel outside of Maine? If so, where?*

Are there any other questions or concerns would you like to discuss with the doctor?*

History questions for Lameness Issues

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