Dog AssessmentDog AssessmentCanine Assessment FormType of pets in your home(Required) Dogs Cats OtherHow many dogs?(Required)How many cats?(Required)How many other?(Required)Travel and OutdoorsHow much time does your dog spend outside each day?(Required)(Hours)Do you take your dog to any of the following? (check all that apply):(Required) Dog Park Doggie Day Care Boarding/Grooming Obedience Training Puppy Classes Organized Competitions OtherOther(Required)Do you travel with your dog?(Required) Yes NoIf yes, where do you go?(Required)Do you take your dog hiking, hunting, camping, or fishing?(Required) Yes NoHome Environment & Home CareDo you observe wild animals or other wildlife in your neighborhood? (check all that apply) Feral Cats Squirrels Chipmunks Skunks Rodents Racoons Deer Wild Turkeys Wild Canines (Coyotes/Foxes) OtherOther(Required)Do you or your dog(s) visit homes where there are other pets?(Required) Yes NoDo other pets come to visit at your home?(Required) Yes NoDoes anyone with a compromised immune system live in or visit your house?(Required) Yes NoHave you seen evidence of fleas, ticks, or worms in any of your pets or in your home?(Required) Yes NoDoes your cat us the litterbox?(Required) Yes NoWhich pets do you treat for fleas, ticks, internal parasites or heartworms?(Required) Dog(s) Cat(s)Please list all of the products, medications, or supplements your dog is using (including flea/tick and heartworm prevention):(Required)What kind of diet do you feed your dog?(Required)Do you feed your dog treats?(Required) Yes NoIf Yes, how many times per day?(Required)What kind of exercise does your dog get?(Required)Unusual BehaviorDoes your dog scratch or bite at its skin or seem itchy?(Required) Yes NoHave you noticed any weight loss or gain?(Required) Yes NoAny recent change in your dog's skin or coat?(Required) Yes NoAny recent change in behavior or activity level?(Required) Yes NoAny signs of pain such as: slow to get up or down or jump, tremor or weakness in the rear legs, or protecting a certain body part?(Required) Yes NoAny recent changes in your dog’s behavior when defecating or urinating?(Required) Yes NoIf Yes, please describe:(Required)No call/ no shows will be charged a 25.00 cancellation feeCAPTCHAΔ
