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Sick Visit Questionnaire
Pets Name
*
Date
*
Owners Name
*
1. Main Concern:
What brings you in today? (Check all that apply)
*
Coughing
Sneezing
Vomiting
Diarrhea
Lethargy
Decreased Appetite
Increased Drinking
Urination
Lameness
Itching
Scratching
Ear Issues
Other
How long has this been going on?
*
Has it been:
*
A
Getting better
B
Getting Worse
C
Staying the same
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