Pet Examination Form: - Olde Towne Pet Resort
Pet Examination Form: - Olde Towne Pet Resort Pet Examination Form: - Olde Towne Pet Resort
Have you heard your dog coughing in the last 2 weeks? Yes No Has your dog had any vomiting or diarrhea in the last 2 weeks? Yes No Brand of food fed at home: Quantity at check in: Dog Examination Form: Dog’s Name: _______________________________________ Suite Number: _____ Weight: _____ Eyes Ears Coat Fleas & Ticks Nose Teeth Gums Feet Pads Nails Hips & Joints Abrasions Lumps Major Medical Problems Allergies Currently on Medications Clear Cloudy Crusty Red Drainage Normal Need Cleaning Possible Infection Normal Thin Dry Oily Needs a bath Matted Hot Spots Is your pet on flea & tick preventative? NO YES Name:___________________________ Drainage Crusty Need dental? Sore Bleeding Pink Red between the toes Dry Cracked Need to be trimmed Notes: Notes: Notes: Notes: Seasonal Skin Food List: None Seen Normal Abnormal Normal Abnormal YES NO YES NO YES NO YES NO YES NO If your dog is finicky in his/her eating habits, may we supplement his/her diet with something else? Green Beans Canned Food Baby Food Chicken Broth Chicken Brown Rice Cheese Peanut Butter Pumpkin Any of these Other____________________ May we feed your dog house food if their food runs out? Yes No If your dog develops digestive upsets while boarding may we initially fast one meal? Yes No And if that does not suffice, may we use one of the following medications (mark all that apply): Revised 4/1/11
Have you heard your dog coughing in<br />
the last 2 weeks?<br />
Yes No<br />
Has your dog had any vomiting or<br />
diarrhea in the last 2 weeks?<br />
Yes No<br />
Brand of food fed at home:<br />
Quantity at check in:<br />
Dog <strong>Examination</strong> <strong>Form</strong>:<br />
Dog’s Name: _______________________________________ Suite Number: _____ Weight: _____<br />
Eyes<br />
Ears<br />
Coat<br />
Fleas & Ticks<br />
Nose<br />
Teeth<br />
Gums<br />
Feet<br />
Pads<br />
Nails<br />
Hips & Joints<br />
Abrasions<br />
Lumps<br />
Major Medical Problems<br />
Allergies<br />
Currently on Medications<br />
Clear Cloudy Crusty Red Drainage<br />
Normal<br />
Need Cleaning<br />
Possible Infection<br />
Normal Thin Dry Oily<br />
Needs a bath<br />
Matted Hot Spots<br />
Is your pet on flea & tick preventative? NO<br />
YES Name:___________________________<br />
Drainage Crusty<br />
Need dental?<br />
Sore Bleeding Pink<br />
Red between the toes<br />
Dry Cracked<br />
Need to be trimmed<br />
Notes:<br />
Notes:<br />
Notes:<br />
Notes:<br />
Seasonal Skin Food<br />
List:<br />
None Seen<br />
Normal<br />
Abnormal<br />
Normal<br />
Abnormal<br />
YES<br />
NO<br />
YES<br />
NO<br />
YES<br />
NO<br />
YES<br />
NO<br />
YES<br />
NO<br />
If your dog is finicky in his/her eating habits, may we supplement his/her diet with something else?<br />
Green Beans Canned Food Baby Food Chicken Broth Chicken Brown Rice<br />
Cheese Peanut Butter Pumpkin Any of these Other____________________<br />
May we feed your dog house food if their food runs out? Yes No<br />
If your dog develops digestive upsets while boarding may we initially fast one meal? Yes No<br />
And if that does not suffice, may we use one of the following medications (mark all that apply):<br />
Revised 4/1/11
Over-The-Counter medications Pepcid Imodium Pepto-Bismol Benadryl Pedialyte all okay<br />
Some dogs exhibit symptoms of stress while boarding. If your dog should become overly<br />
stressed we have an all-natural flower remedy called Rescue Remedy.<br />
Would this be okay to give to your dog? Yes No<br />
Owner’s Signature: __________________________________________<br />
Examiner’s Signature: ________________________________________<br />
Date: ________________<br />
Date: ________________<br />
For OTPR<br />
Notes:__________________________________________________________<br />
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Revised 4/1/11
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