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Annual Exam Questionnaire

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Annual Exam Questionnaire

    Welcome back to Bridgewater Veterinary Hospital for your pet’s annual exam! Please help us update our records by taking a few moments to fill out this information completely!

    Habitat:
    Water consumption:
    Foods
    Food Type:
    Appetite:
    Change in appetite:
    Activity Level:
    Behavior
    Have you noticed changes in your pet’s ability to walk, jump, or run?:
    Vomiting:
    Diarrhea:
    Straining to defecate:
    Straining to urinate:
    Coughing:
    Sneezing:
    Nasal discharge:
    Itching:
    Does your pet have or need the following items?
    Heartworm Preventative:
    Flea and tick preventative:
    Premium or therapeutic food:
    Multivitamins:
    Shampoo approved safe for adult dogs or cats:
    Collar and leash/microchip/ID tag:
    Chew toys approved safe for adult dogs or cats:
    Home dental-care products:
    Medications