Drop Off/While Boarding Exam | Animal Clinic of Windermere

Owner's Name*

First Last

Pet's Name*

Please describe what we are seeing your pet for?*

How long has your pet displayed these symptoms?*

Is your pet eating and drinking normally? If not, please describe.

What are you currently feeding? Please include all dry kibble, canned food, and people food.

Is your pet going to the bathroom normally and daily? If not, please describe.

Any additional concerns, lumps, bumps, cuts, or sores that you wish to have us look at?

Is your pet currently receiving any of the following preventative medications?

Other

**If your pet is found to have external parasites (fleas or ticks) during the exam, an appropriate treatment will be administered at an additional cost**

Is currently receiving any other medication? If so, please list medications and doses.

In order to diagnose your pet's condition, your pet may require blood tests, radiographs and/or other diagnostic testing. Would you prefer that we:*

Proceed with any doctor recommended diagnostic testing.
Contact you prior to performing any diagnostic testing. Please provide a phone number:

Signature*

Date*