Annual Wellness Survey

Email us at: info@adamstownvet.com

Our Location2481 N Reading Road, Denver PA

Open Mon-Satat 8 AM

Call: 717-484-0440Text: 717-925-3867

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Annual Wellness Survey

Adamstown Veterinary Hospital > Annual Wellness Survey

Annual Wellness Survey

Please complete the below questionnaire, it will help us “tail”or your pet’s upcoming appointment. Make sure to fill out all the questions with complete information.

Pet Name *

Pet Owner *

First

Last

Email, in case we have more questions *

Have you noticed any health issues or physical problems with your pet in the last 6 months?

What type and brand of food do you feed your pet? (for example Hill's Healthy Weight Dry food)

How much do you feed your pet daily? (for example 1 1/2 cups dry)

Have your pet's eating habits changed in the past 6 months?

Yes
No

If you answered yes, please describe how they have changed.

Did your pet miss any doses of their monthly Heartworm medication? (Heartworm medication examples - Interceptor, Sentinel, Heartgard)

No, my pet receives their medication monthly
Yes, I have missed doses recently.
I do not give my pet any medication

Did your pet miss any doses of their Flea/Tick medication? (Flea/Tick medication examples - Bravecto, Nexgard, Simparica, Revolution for Cats)

No, my pet receives their medication. monthly
Yes, I have missed doses recently.
I do not use Flea/Tick medication.
I use a Flea/Tick product, I purchase elsewhere.

If you use a Flea/Tick medication that you purchase elsewhere, what is the name of the product?

Have you seen Fleas or Ticks on your pet?

Yes
No
My pet does not go outside.

Does your pet do any of the following? Check all that apply.

Boarding
Grooming
Dog Parks
Frequent Walks
Is an indoor/outdoor cat
Is housed outdoors

Has your pet had any of the following recently? Check all that apply.

Vomiting
Diarrhea
Coughing
Sneezing
Urinating frequently
Not urinating
Constipation
Itching/Scratching
Bad Breath
Urinating outside the litterbox
Behavioral Changes

If your pet has a history of any of the above symptoms recently, can you describe in more detail.

Do you give any vitamins, supplements or medications? If so, what are they and how much do you give? (For example, Thyroid Medication 1/2 tablet once daily in the morning)

Do you have any other health concerns regarding your pet that you would like to discuss?

Is there anything else you would like to share with your veterinarian?

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Our Hours

Monday 8 AM to 6 PM

Tuesday 8 AM to 6 PM

Wednesday 8 AM to 6 PM

Thursday 8 AM to 6 PM

Friday 8 AM to 6 PM

Saturday 8 AM to 12 PM

Sunday Closed

Contact Us

2481 N Reading RoadDenver, PA 17517
Customer Support : 717-484-0440
Email :info@adamstownvet.com

Payment

We proudly accept Visa, Mastercard,
American Express and Discover. We do not accept personal or business checks.

Care Credit with 6 months interest free financing is offered. Apply today at carecredit.com. Terms and Conditions apply.

Have pet insurance? Our team is familiar with major
carriers like Pet Plan, Embrace, Trupanion, and more. We can assist you when sending in your claim information.

copyrights © 2019 Adamstown Veterinary Hospital Updated on 4/16/2019