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Hours & Contact
Monday/Tuesday/Thursday/Friday: 9:00am-6:00pm
Wednesday: Closed
Saturday 9:00am-1:00pm (please call - open 3 Saturdays a month)
(734) 655-0012
[email protected]
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Questionnaire
Date of Appointment
Owner Name
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Last
Best Phone
Please provide the best phone number to reach you.
Email address
Pet Name
Reason for visit
Is your pet taking heartworm medication monthly?
Yes
No
If yes, what is the name of the heartworm medicine?
If no, when was the last dose given?
Is your pet taking flea and/or tick prevention monthly?
Yes
No
If yes, what is the name of the medicine?
If no, when was the last dose given?
Is your pet currently taking any medications?
Yes
No
If yes, please describe the medication(s) and dose(s).
Is your pet experiencing any of the following symptoms?
Coughing or sneezing
Vomiting or diarrhea
Change in appetite or thirst
Observed lumps / bumps
Observed scratching or licking
Soreness or stiffness
Change in outside (or litterbox) habits
Notable change in weight
Any behavior changes
Do you have pet insurance for him/her
Any other issues not listed here?
What diet (and amount) are you feeding your pet?
What treats and/or human food do you feed your pet?
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