EXAM Vomiting/Diarrhea EXAM Vomiting/Diarrhea 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 pet start experiencing symptoms?*What exactly are you seeing at home?*If your pet is vomiting, approximate how many times per day: Describe the vomit (large puddles, small foamy vomit, blood in it, etc): If your pet is having diarrhea, approximate how many times per day: Describe the diarrhea (large puddles, small droplets, blood in it, any mucous, etc): Stool Quality Score*Please rate your pet's stool quality score from 1-5, 1 being being extremely hard, 5 being profuse diarrhea12345Have you noticed any changes in your pet's personality or behaviours?* yes no 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?*When was the last bag of food opened?* In your opinion, is your pet drinking more frequently?* yes no unsure In your opinion, is your pet urinating more frequently?* yes no unsure Have there been any recent accidents in the house?* yes no Has there been a change in your pet's level of energy?* yes no Does your pet hunt?* yes no Does your pet eat feces/drinks outdoor water from wildlife/other pets/its own?* yes no Does your pet roam freely outdoors?* yes no Does your pet have possible access to the compost/garbage/recycling?* yes no unsure Is there a chance your pet ingested a foreign object (sock, toy, medication, etc)?* yes no unsure 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?* Have you brought a stool sample today?* yes no 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:Is anyone in your household allergic to peanut butter?* yes no Δ