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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