Preventive Care

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603


Preventive Care Exam Form

Name (required)
First Name (required)
Last Name (required)
Patient Name (required)

Please list the brand, type and amount of food your pet is currently been fed.

Have your changed your pet's diet lately? If so, why and any changes in health you have noted.

Please list any treats or human food your pet routinely eats

Please list any medications or supplements you give your pet routinely or infrequently.

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

Does/will your dog be
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?
Excessive Panting
Drinking More
Urinating More
Urinating Inappropriately
Decreased Appetite
Increased Appetite
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
Please list any other concerns you have for your pet at this time

Does or has your pet travelled outside of Alaska? If so, please list states/countries visited:

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