Annual Wellness Exam Questionnaire
Please fill out this form to the best of your ability prior to your appointment. If you have any questions or concerns prior to your appointment please contact our office at (315)673-4858 or via email at contact@lcvetcare.com. We are looking forward to your visit!
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Date *
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Client Name *
Pet Name *
At this time Lake Country is operating curbside. As a result, we will have you wait outside in your vehicle while your patient is taken inside the building for examination. Once the doctor has completed their exam, they will call you from inside the building to discuss.  Please provide the number you wish us to use on the day of your appointment.
Phone Number *
Is this your pet's first visit with us? *
* If this will be your pet's first visit please make sure that any and all previous medical records are sent prior to your scheduled appointment *
What wellness/preventative care services are you interested in today? *
Required
Has your pet ever had an adverse reaction to drugs, supplements, or vaccines? *
If your pet has adverse reactions to vaccinations, have you already given an antihistamine before today's appointment?
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Is your pet currently receiving any parasite preventatives (i.e. heartworm, flea/tick)? *
What heartworm and/or flea and tick prevention is your pet on? *
Required
Will you need a refill of preventatives for your pet? *
If yes, what preventatives will you need a refill of?
What do you feed your pet and how much? *
Does your pet have any chronic or recurring problems, injuries or illnesses? *
If yes, what is your pet's chronic or recurring condition?
Is your pet currently on any prescription medications or supplements? *
If yes, what medications or supplements does your pet receive? How much do you give and how often are they given?
Environmental/Lifestyle
Does your pet...
Medical Concerns
Do you have any concerns that you would like to address with the doctor? *
Required
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