Preventative Care

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603

(907)235-8960

www.homervet.com

Preventative Care Form

Please list the type and amount of food your pet is currently eating

Has your pet's diet changed? If so, when?

Please list any treats or human food your pet routinely eats

Please list any Medication or Supplements you give your Pet

Do you have any other pets (if so) please let us know species/number?

Does/will your dog be
Boarding
Visiting the Beach/highly dog populated areas
Visit Groomer
Attend Dog Day Care or Dog Playgroups
Attend behavior or agility classes or dog shows
Does your dog
Roam outside of the yard
Is Fenced
Is your CAT or will your CAT be
Inside always
Indoor & Outdoor
Outdoor only
Please check the box if you pet needs
Nails Trimmed
Anal Glands Expressed
Refill of Medication(s)
Has Your Pet Experienced any of the following in the last 30 days?
Coughing
Sneezing
Excessive Panting
Vomiting
Diarrhea
Drinking More
Urinating More
Urinating Inappropriately
Scooting
Decreased Appetite
Increased Appetite
Limping
Troubel getting up or around
New or Changing Lumps
Seizures since last exam
Behavior Changes
Bad Breath Dental Issues
Ear Issues
Eye Issues
Excessive Scratching or Licking
Fleas
Please list any other concerns you have for your pet at this time

Does your pet travel out of state? If so, please list states/countries visited:


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