Pre-Exam Questionnaire Fill out the form below and a member of our team will get back to you shortly if we have any questions. get started 7 Pre-Exam Questionnaire Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Patient Name:Please list all medications your pet is currently taking:Below you will find a checklist of common indicators of medical problems in pets. Please mark each that applies in order to facilitate the diagnostic process for our doctors and staff. This greatly assists us in providing the best possible care:Increased or decrease in appetiteIncrease or decrease in drinkingIncrease or decrease in weightChange in frequency of urination/amount of urineAny diarrhea or vomitingProblems with control of urination or bowel movementsBehavioral changes/abnormal behavior (i.e. increased aggression, disinterested, etc.)Apparent confusion, disorientation, pacing, vertigoIrregular sleep patterns/restlessnessLimping, stiffness, discomfortLethargy and/or difficulties with physical activityItchy, irritated, and/or flaky skinAny new or growing bumps or lumpsHead shaking/dirty ears/head shakingAbnormal coughing and/or sneezingDifficulty eating and/or mouth odor My pet is healthy, and does not appear to have any of the problems listed above.Please list any other concerns you would like to discuss below: Have you recently traveled anywhere within the continental United States? If so, please list: Have you recently traveled anywhere outside the continental United States? If so, please list:Extracurricular activities (check all that apply):BoardingDaycareDog ParkGroomingPet StoreOtherIf 'Other', please specify:Submit