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7985 FM 78 San Antonio, TX 78244
 


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Medical History / Risk Assessment


Pet's Name*
Owner's Name*




First




Last


Reason for visit:*
Current medications/supplements:*
Do you ever give your pet over-the-counter medications (i.e. Aspirin, Tylenol, Advil, etc)?*
Yes
No
Has your pet  been diagnosed with a heart condition or have a history of seizures?*
Yes
No
Please list any other pets on the household (names, species, and breeds):*
Conditions
Please check all that apply.
Mouth*


No Problems


Bad Breath


Difficulty Eating


Other
If other, please specify:
Eyes*


No Problems


Vision Loss


Drainage


Other
If other, please specify:
Ears*


No Problems


Scratching


Odor


Other
If other, please specify:
Skin*


No Problems


Scratching


Hair Loss


Other
If other, please specify:
Appetite*


Normal


Decreased


Increased
Water Intake*


Normal


Decreased


Increased
Urination*


Normal


Decreased


Increased
Activity*


Normal


Decreased


Increased
Mobility*


Normal


Decreased


Increased


Inability to Stand


Inability to Jump Up


Inability to Run
Coughing*
No
Yes
If yes, describe frequency:
Sneezing*
No
Yes
If yes, describe frequency:
Vomiting*
No
Yes
If yes, describe frequency:
Diarrhea*
No
Yes
If yes, describe frequency:
Bahavior*
No
Yes
If yes, describe frequency:
Are your pet's vaccinations up to date?*
Yes
No
If no, what vaccinations are needed:
Previous surgeries/problems:*
What do you feed your pet?*
How often do you feed your pet?*
Does your pet stay:*
Inside
Outside
Both
Does your pet (check all that apply):


Go to Parks/Trails


Travel With You Out of the Area


Boarded/Groomed
What parasite control do you use?*


 












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Our Location
 
7985 FM 78

San Antonio, TX 78244
 
Contact
 
Phone: (210) 661-4201
Hours
 
Monday: 7:00 am – 5:00 pm

Tuesday: 7:00 am – 5:00 pm

Wednesday: 7:00 am – 5:00 pm

Thursday: 7:00 am – 5:00 pm

Friday: 7:00 am – 5:00 pm

Saturday: 8:00 am – 11:00 am NO Appointments

Sunday: CLOSED


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