PRE-CONSULTATION QUESTIONNAIRE

info@chertseyvets.co.uk

Phone: 01932 565 082

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Pre-consultation

Questionnaire

Please complete the pre-consult questionnaire for your pet before you come to visit us

You can submit it here, or you can complete it when you come into the clinic

Just ask if our reception team can help you

Your Pet's Breed

Your Pet's Birthday

Female

Female Neutered

Male

Male Neutered

Your Pet's Insurance Company

When did you last use a worming product, and can you tell us the name of the product if you can recall it?

When did you last use a flea treatment product, and can you tell us the name of the product if you can recall it?

When was your pet's last vaccination or titre test?

How do you stay organised and budget for your pet's preventiative healthcare throughout the year? Do you buy flea and wormers monthly, do you add reminders into your diary?

What does your pet nomally eat? Tick all that apply

Dry (kibble/biscuits)

Wet (canned meat)

Raw

Other

My pet's breath:

Is lovely, and smells great

Can be a bit smelly

Is getting smellier

Is really smelly

When did your pet last have a dental hygeine check-up or procedure?

Have you noticed any changes in your pet's behaviour or demeanour? Slight changes can be an early sign of a problem, and you know your pet better than anyone! By telling us now, you may help us detect a condition sooner.

Weeing - increased amount/decreased amount/more or less frequent/change in colour

Pooing - constipation/loose faeces/mucous/blood present

Activity levels - increased/decreased

Drinking - increased/decreased

Appetite: increased/decreased/changed

Stiffness noticed after exercise, or after resting

Scratching at ears/skin

Coughing or sneezing

Thanks for submitting, your vet will take a look shortly!

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