CANINE Puppy NEW Wellness Exam CANINE Puppy NEW Wellness Exam 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:* How long has it been since you've owned a puppy? If this is your first puppy, please indicate.* Where did you obtain your puppy?* breeder pet store shelter rescue organization humane society How long have you had your puppy?* How old was your puppy when you obtained him/her?* How old were the puppies when they were taken away from their mother?* Have you seen his/her parents?* yes no Did he/she have his/her first set of vaccines?* yes no Where does your puppy spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?Are there things your puppy is afraid of or does not like? If so, please describe:*Have you heard about our health plans?* yes no What food are you feeding your puppy? Please upload a photo below: Drop files here or Select files Max. file size: 300 MB. Is your puppy fed a grain-free diet? Yes No How often do you feed your puppy?*What human food/homemade cooking or treats does your pet get?Do you feel your puppy is peeing and pooping normally? If no, please describe why not)* What, if any, medications (over the counter or prescription) does your puppy take or have been applied routinely? Upload photos of products, if any. Drop files here or Select files Max. file size: 300 MB. Stool Quality Score (Please bring poop sample to your appointment)!*Please rate your pet's stool quality score from 1-5, 1 being profuse diarrhea, 5 being extremely hard.12345Please rate your pet's itchiness score from 1-10, 1 being not itchy at all, 10 being extremely itchy.*12345678910Is your puppy on flea/tick prevention currently?* yes no Have you seen any ticks or fleas on your puppy?* yes no Have you seen any ticks or fleas on your puppy?Would you like us to get your pet started on the Lyme vaccine? Yes No Does your pet have a history of vaccination reaction?* Yes No Never been vaccinated Would you like us to temperature microchip your pet today? A temperature microchip not only will increase the chance of your pet being returned home if he/she is missing AND allows us to obtain his/her temperature non-rectally.* yes no he/she is already microchipped Does anyone in your household have a peanut allergy?* Yes No Please list any questions/problems/concerns for Dr. Jinni that you would like addressed: Δ