Form Annual Exam Questionnaire Welcome back to Bridgewater Veterinary Hospital for your pet’s annual exam! Please help us update our records by taking a few moments to fill out this information completely! Owner's First Name * Owner's Last Name * Email * Pet's Name * Date * Habitat: Indoor onlyMostly indoorOutdoor onlyMostly outdoorIn and out freely Water Consumption: NormalDrinks excessivelyAmount upAmount down Foods Food Brand & Amount Food Type: Eats specific mealsFed free choiceTable foodTreats Appetite: Very goodGoodPickyPoorVery poor Change in Appetite: UpDownNo change Activity Level: Very activeNormalVery inactiveMore activeLess active Behavior Any notable change in behavior? Have you noticed changes in your pet’s ability to walk, jump, or run?: YesNo Vomiting: None/uncommonOccasionallyFrequently Diarrhea: None/uncommonOccasionallyFrequently Straining to defecate: YesNo Straining to urinate: YesNo Coughing: NoneOccasionallyFrequently Sneezing: NoneOccasionallyFrequently Nasal discharge: NoYesPusWateryBloody Itching: SeasonalYear-round Does your pet have or need the following items? Heartworm preventative: Have ItNeed It Flea and tick preventative: Have ItNeed it Premium or therapeutic food: Have ItNeed it Multivitamins: Have ItNeed it Shampoo approved safe for adult dogs or cats: Have ItNeed it Collar and leash/microchip/ID tag: Have ItNeed it Chew toys approved safe for adult dogs or cats: Have ItNeed it Home dental-care products: Have ItNeed it Medications Medications regularly taken If you are human, leave this field blank. Submit
