CANINE Parasite Control CANINE Parasite Control This form is designed to help our team gather important information about your pet's current status for your upcoming visit to our Fear Free clinic! Your pet's name:*Your name:*Where does your dog spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?*Have you taken your dog to any training classes? If so, where?Do you walk your dog? If so what type of collar does your dog wear for walks?*Please rate your pet's itchiness score from 1-10, 1 being not itchy at all, 10 being extremely itchy.*12345678910Has there been any change in frequency or urination or defication?* yes no Stool Quality Score*Please rate your pet's stool quality score from 1-5, 1 being profuse diarrhea, 5 being extremely hard.12345Did you bring a stool sample today?* Yes No What, if any, medications (over the counter or prescription) does your dog take or have applied routinely?Does your pet attend grooming/boarding/daycare/dog park facilities?* Yes No Does your pet hunt?* Yes No Does your pet eat feces/drinks outdoor water from wildlife/other pets/its own?* Yes No Was your pet living in or traveling with you to heartworm/tick endemic area in the last 12 months? (States, south west/Northern Ontario)?* Yes No Is your pet on heartworm prevention? Please also upload any photos of the products your pet is on. Drop files here or Select files Max. file size: 300 MB. Do you have any doses leftover from last year?* Yes No Is your pet on flea/tick prevention currently?* Yes No When was approximate last time you found ticks on your pets, if any? (Date)Would you like us to get your pet started on Lyme vaccine?* Yes No How did your pet do after last year's vaccines? Was there any reaction to the vaccines?* Yes No Is your pet microchipped?* Yes No Has your pet bitten any person in the last 10 days which broke the skin?* Yes No Does anyone in your household have a peanut allergy?* Yes No Δ