Patient History Form
Your Name:
Phone Number:
Pet Name:
Home Care
Does your pet spend time:
Indoors Outdoors Both
Does your Pet have Microchip?
Yes No Unsure
What brand of food does your pet eat?
How much does your pet eat? Amount:
Frequency Once a Day Twice a Day Others
Dental Care provided at home? How often? Brushing Dental Chews Mouth Rinse Water Additive Other
Medical History
Has your pet exhibited any of the following symptoms? If yes, how long have these symptoms persisted?
Coughing Yes No
If Yes, how long?
Sneezing Yes No
Vomiting Yes No
Diarrhea Yes No
What other symptoms has your pet exhibited?
Have you noticed any changes in your pet‘s behavior or eating and drinking habits? If so, please explain.
Does your pet have any ongoing medical conditions (e.g. seizures, allergies, limping, masses/tumors, etc.)? Please include dates and specific locations on the body if applicable.
Medication
Please fill out with as much detail as possible or write n/a if no medications apply. List recently discontinued medications as well.
Heartworm preventive:
Administered on:
How often?
Flea and tick preventive:
Is your pet taking any other medications?
Questions or concerns?
Please initial here
Signature will be required upon check-in
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Quality professional team members that pride ourselves in furthering education to ensure your pet gets the most quality care they can.
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Testimonials
"I have been going to Dogwood for 6 or 7 years and have never had a negative experience! My young golden retriever goes regularly to Daycare and can hardly wait to get in the door when I drop her off! She runs to greet the reception staff and drools for her cookie! Just look at some Facebook pictures and you will see what a great time the dogs have! She comes home tired and happy! The staff knows her and always let me know if there were problems during the day! A very caring, supportive group! Wouldn't take my girls anywhere else!"
"Molly and PeeWee know, as soon as I get out the special blankets and the bag with their Dogwood tags, that they are coming to stay with you and get pampered. They run in circles and race to their leashes. Once they are at the resort and spa, they enthusiastically greet the staff and head back to their room. I greatly appreciate that they can be boarded together and that everybody understands their special needs. It is an honor and a privilege to recommend you and your practice. Thanks for everything you do for me and my family members. I always feel completely confident that you and your staff will treat them as if they were your own family members, with great care and concern."
"We are so grateful to have Dogwood Veterinary Hospital for our three Boxers. If one were able to dream of the perfect care animal practice for our best friends, this is it!! Dogwood provides the highest level of professional care for our dogs. From the phenomenal doctors and vet techs, warmth and efficiency of staff and the kindness and love showed by all, Dogwood continues to exceed our expectations. We know our pets are in the best of hands and that is comforting beyond words"
"Today we are the proud companions of a gorgeous Aussie mix, Hildy. She gives us unconditional love and boundless joy – but she was not always this way. In 2009, when we adopted her from a kill shelter, Hildy was a terrified creature who would not look at us or eat from our hand. She clearly was a dog who had known no love. We were at odds regarding what to do with her. After several trainers said she was a hopeless case, we decided that perhaps she needed daily care with professionals. We luckily chose the caregivers closest to our home, Dogwood Daycare! Within two weeks, Hildy was looking at us and taking food. She even wagged her tail a little! No words express our deep and ongoing gratitude to the Dogwood staff for making our treasured Hildy understand that humans, too, can love."