CANINE Puppy Wellness Exam CANINE Puppy 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:*Have you activated your free Emergency 30-day Trupanion Insurance voucher?*Where does your puppy spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?*Is your puppy house trained? Yes No Is your puppy enrolled in a puppy classes? If so, where?*If you have other pets in the household, describe the puppy’s relationship with them:Has your puppy ever shown any growling, barking, snarling or mouthing/biting towards you or anyone else? If so, what are the triggers?*Are there things your puppy is afraid of or does not like? If so, please describe:What type of food do you feed your puppy? Upload a photo of the food below:Photo UploadMax. file size: 300 MB.Is your pet fed a grain-free diet? Yes No How often are you feeding your puppy?*What human food/homemade cooking or treats does your pet get?*Are you happy with your puppy's water and food consumption?*Are you concerned with your puppy's urination or defication?*What, if any, medications (over the counter or prescription) does your puppy take or have been applied routinely? Upload photos of the products, if any: Drop files here or Select files Max. file size: 300 MB. Stool Quality Score (Please bring a 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.*12345678910Have you seen any worms in your puppies stool?* Yes No Have you seen any ticks or fleas on your puppy?*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