Canine Appointments Contact InfoName* First Last Email* PhoneDog's NameBreedColorPet's Date of Birth/Age Date Format: MM slash DD slash YYYY SexMaleMale - NeuteredFemaleFemale - SpayedPrimary Reason for Today's VisitWhat brings you in to our hospital?Wellness ExamSick - ExamDo you have any concerns about your pet's health?YesNoPlease elaborate: Have you tried anything to treat these problems so far?Tell me about your pet's lifestyle:Describe their diet:Describe what medications and supplements your pet is taking:Which heartworm preventative do you give your pet?Interceptor+Proheart injectionOtherWhat heartworm preventative do you use?Which flea/tick preventative do you give your pet?Vectra 3DBravectoCredelioOtherWhich flea/tick preventative do you use?How many months a year does your pet receive heartworm and flea/tick medication?Please enter a number from 1 to 12.Do you need refills on heartworm or flea/tick preventatives or any other medications?YesNoDoes your pet have a microchip?YesNoMicrochipping is permanent identification that we recommend for all dogs and cats!. Having your pet microchipped will help you be reunited if they become lost! We recommend Bordatella and Canine Influenza vaccinations for all dogs that are boarded, traveling, groomed., or attend doggy day care or training classes. If your dog is social and goes to dog parks or plays with other dogs in the neighborhood, we also recommend influenza vaccine but bordatella is not needed because they are not inside with other dogs. A fecal sample should be checked yearly for intestinal parasites. Please bring in a stool sample collected the day of your appointment. Year round heartworm prevention is needed as mosquitos are now known to live in your basement/attic and in the sewer system all winter. We offer the following options for Heartworm Prevention for dogs 1. ProHeart 6 injection given in the hospital - this lasts 6 months 2. Interceptor Plus -once a month oral chew tablet Heartworm prevention purchased form non-veterinary sources are NOT guaranteed by the manufacturers. We recommend to purchase the products from our hospital or our online store to ensure the manufacturer guarantees are in effect to reimburse for intestinal parasites and heartworm treatment if your dog should contract heartworm while on prevention. Since lyme disease and ticks are so prevalent in our area , we recommend lyme vaccination and flea/tick prevention year round for all dogs! The deer tick that spreads lyme disease is also carried by songbirds- you don't need deer in your yard to bring in ticks! 1 Bravecto - oral chewable tablet given every 3 months for dogs > 6 months of age 2. Credelio- oral chewable tablet given once a month for dogs > 8 weeks of age 3. Vectra 3D -- monthly topical - only product with repellant action for mosquitos We will discuss pricing options for your dog’s heartworm and flea/tic k prevention during your visit. Our hospital offers wellness plans that allow you to spread your veterinary costs over the year with monthly payments. Pets on the wellness plans receive FREE exams, nail trims, anal gland expressions and ear cleanings all year long! If you are using a promotional discount such as Care to Share please let us know when you check in- we want to thank the person that recommended you to our hospital! You will each receive a $25 credit on your account! We look forward to meeting you and your pets!