Patient Questionaire

Thank you for being a concerned pet parent. Please fill out this questionnaire as best you can. Feel free to leave things blank or ask you own questions.
Please submit it this as soon as possible prior to your appointment so that we may focus our visit on your pet’s care.

If I am seeing your pet at home please have your veterinarian email your pet’s medical records before your appointment day to: info@vox.vet. (If I do not receive records I may not be able to make the proper medical recommendations.)

* Indicates required field

Your Name *

First

Last

Email *

Pet’s name *

Phone Number *

What is your main concern regarding your pet’s health and what would you like to accomplish during our appointment? *

On a scale from 0-10 (0 being no pain and 10 being the worse, extreme pain) how much pain do you feel your pet is experiencing at it’s worse? *

What other health issues are present? *

What medication and/or supplements is your pet currently taking? *

What previous medication has your pet taken in past? Please list allergies, side effects or adverse reactions. *

What is your pet’s diet and how is his/her appetite? *

Is your pet being managed with any other type of physical therapies,rehabilitation or body work? *

What is your pet’s daily activity level? Include walks for eliminations, litter box use as well as play time *

Does your pet’s environment consist mostly of hardwood/tile floors or carpeted areas? Does your pet like to be up in furniture? *

Other pets in the house? Does your pet engage with them? Any children in the household? Does your pet engage with him/her/them? *

When feeling good, what is your pet's personality like? Any behavior issues? Please also add any other comment you'd like me to know. *

Please choose the reason(s) for your appointment. *

Pain Consult Acupuncture Quality of Life Consult Medical History Review

Submit