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PET POISON CONTROL INFORMATION
Call or Text Us: 713-643-0633
Visit Us: 7327 Long Drive Houston, TX
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About Us
Our Team
Promotions
Payment Options
Careers
Contact
New Clients
What To Expect
New Client Registration Form
Patient Health History Form
Services
Veterinary Services
Boarding Services
Grooming & Spa Services
Pet Health
Pet Health Checker
Pet Health Library
How-To Videos
Pet Food Recalls
Pet Dental Care
Product Recalls
Pet Insurance Information
News
Pet Portal
Book An Appointment
Refill Requests
Mobile App
Online Orders
Online Food Orders
Online Pharmacy Orders
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Patient Health History Form
Thank you for taking the time to complete the form below prior to your pet’s appointment. We look forward to seeing you and your pet soon!
Pet Owner’s Name
*
First
Last
Phone Number
*
Email
*
Patient Name
*
Pet Breed
Pet Age/Date of Birth
Date
*
Date Format: MM slash DD slash YYYY
Is your pet eating and drinking normally?
*
Yes
No
Please describe symptoms and duration:
*
What diet is your pet currently on?
*
Has your pet been experiencing vomiting or diarrhea?
*
Yes
No
Please describe symptoms and duration:
*
Is your pet coughing or sneezing?
*
Yes
No
Please describe symptoms and duration:
*
Is your pet currently taking a flea/tick preventative?
*
Yes
No
Please list the product name and frequency given:
*
Is your pet currently taking a heartworm preventative?
*
Yes
No
Please list the product name and frequency given:
*
Is your pet currently taking prescription medication(s)?
*
Yes
No
Please list the medication name(s), frequency given, and prescriber’s name:
*
Please list the condition for which your pet’s medication was prescribed:
*
Do you need medication refills?
*
Yes
No
Please list the medication name(s), frequency given, and prescriber’s name:
*
Please describe symptoms and activities surrounding anxiety episodes:
*
Have you noticed your pet behaving abnormally recently?
*
Yes
No
Please describe symptoms and duration:
*
Does your pet scratch, lick, or chew at their skin, fur, feet, or bottom?
*
Yes
No
Please describe symptoms and duration:
*
Does your pet experience stiffness or soreness?
*
Yes
No
Please describe describe the location and when the change was first noticed:
*
Have you noticed any new lumps, bumps, or growths on your pet?
*
Are you planning to board your pet in the near future?
*
Yes
No
Please list upcoming boarding dates and facility:
*
Has your pet stayed at a boarding facility since your last visit?
*
Yes
No
Please list most recent boarding dates and facility:
*
Please list any additional health history you’d like to share:
*
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About Us
Our Team
Promotions
Payment Options
Careers
Contact
New Clients
What To Expect
New Client Registration Form
Patient Health History Form
Services
Veterinary Services
Boarding Services
Grooming & Spa Services
Pet Health
Pet Health Checker
Pet Health Library
How-To Videos
Pet Food Recalls
Pet Dental Care
Product Recalls
Pet Insurance Information
News
Pet Portal
Book An Appointment
Refill Requests
Mobile App
Online Orders
Online Food Orders
Online Pharmacy Orders
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