Lameness Exam Lameness 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:* What symptoms is your pet experiencing?*Was there an accident or trauma that occured that you are aware of (i.e. fall from a couch or bed)?Where does your dog/cat spend most of his/her day? (inside, outside, in a room, in a kennel, with you)?When your pet experiencing the most mobility problems (i.e. in the morning, on stairs, after a walk, getting up from the floor)Which limb(s) is experiencing problems?Do you have any problems with walking your pet (if applicable)?Is your pet on any medication? If so, what type, how often?Any change in grooming or sleeping habits?Are change in food/water consumption?*Has your dog ever shown any signs of aggression towards you or anyone else? If so, when?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 kind of food do you feed your pet? Upload photos of the product: Drop files here or Select files Max. file size: 300 MB. How often is he/she fed?*Is food available all the time or at set "mealtimes"?What human food/homemade cooking or treats does your pet get?Is your pet fed a grain-free diet? Yes No 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? (Dogs only) 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 Please list any questions/problems/concerns for Dr. Jinni that you would like addressed:Does anyone in your household have a peanut allergy?* Yes No Δ