EXAM CANINE Inappropriate Urination EXAM CANINE Inappropriate Urination 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:* When did your dog start experiencing symptoms?*What exactly are you seeing at home?*If your dog is urinating inappropriately, approximate how many times per day:* What does the urine look like? Describe if the puddles are large, small, if you notice blood in it, etc.* Stool Quality Score*Please rate your pet's stool quality score from 1-5, 1 being profuse diarrhea, 5 being extremely hard.12345Describe the diarrhea, if any. Are there large puddles, small droplets, does there appear to be blood or mucous in it?Does your dog have a history with the same issue? Please describe:*What kind of food are you feeding your pet?*Is your pet fed a grain-free diet? Yes No How long has your pet been on this diet?*What table scraps/homemade cooking or treats does your pet get?*In your opinion, is your pet drinking more frequently?* yes no unsure In your opinion, is your pet urinating more frequently?* yes no unsure Does your pet eat feces/drinks outdoor water from wildlife/other pets/its own?* yes no Does your pet hunt?* yes no Does your pet roam freely outdoors?* yes no Is your pet on flea/tick prevention currently?* yes no Have you seen any fleas/ticks on your pet in the last year?* yes no Which flea/tick product do you use for your pet? Do you still have any remaining?* When was your pet last dewormed?* Has your pet bitten any person in the last 10 days which broke the skin?* Yes No Please list any questions/problems/concerns for Dr. Jinni that you would like addressed:Does anyone in your household have peanut allergy?* yes no Δ