Contact Us Once you hit the submit button at the end of this form, a copy of the form will be sent to you at the "owner email address" that you provide. If you would like the information sent to a second email, please enter the address in the "other email" field at the end of the form.Pet's NameOwner/ Account Name First Last Your email address Today's Date MM slash DD slash YYYY What is your pet's general demeanor?Has his level of activity changed? Yes NoDescribe activity changeHas his interest in playing changed? Yes NoDescribe the interest in playing changeDoes he tire more easily? Yes NoComments - Tire easilyDoes he sleep through the night? Yes NoComments on sleepingAre his eyes ...? Bright Dull NormalDoes he have a discharge from his eyes? Yes NoWhat color is the discharge?Does he hug the wall or the furniture when he walks? Yes NoComments about eyes or eyesightHas his hearing changed? Yes NoComments about HearingHas he become..? more vocal less vocal no changeComments on VocalDoes he paw at his ears? Yes NoDoes he scratch his head, muzzle, or ears on the carpet or furniture?? Yes NoComments about pawing ears or scratching head on objectsWeight - Is he...? Overweight? Underweight? Unexplained weight change?Please describe weight changeHas his appetite changed? Yes NoIs he drinking more or less water than usual? More Less SameDoes he have a cough? Yes No SometimesWhat does his cough sound like?Does he have..? Vomiting Diarrhea Constipation NonePlease explainDoes he drag his bottom or scoot his rear across the grass or carpet Yes NoPlease explainWhat is the condition of his coat? Shiny Dull Lifeless Dry Bald Spots Bare Spots Coat has thinnedIf coat has thinned, is the thinning.. All over Certain AreasCoat condition - commentsHas he been scratching? Yes No More than usual but not alarmingIs he scratching..? All over In one particular spot Certain times of the year Under certain conditionsComments on ScratchingWhat is the condition of his nails? Normal OtherDescribe condition of the nails that are other than normalAre there any unusual or unpleasant odors from his....? Mouth Ears Skin none - normalDescription of odorsIs he alert and listening to you? Yes NoDescribe change in alertness/listeningIs he having more accidents than usual? Urine Feces NormalComments about accidentsDoes he appear to be in pain? Yes NoSigns of pain - does he..? Back away when you try to touch him in certain places? Growl when you touch him? Favoring or guarding a part of his body?Comments about painHas there been a recent injury? Yes NoPlease explain recent injuryAre his movements smooth? Yes NoWhen he moves, is his reach even on the left and right sides?? Yes NoDoes he favor one paw or leg over the others? Yes NoMovement commentsDoes he show stiffness in his joints? Yes NoDoes he have difficulty lying down or getting up? Lying down Getting up No difficultyDoes he hold his head erect and straight? Yes NoComments - Head erect and StraightAny other comments or observations:Other email - enter an additional email address to have this information sent to a second email.
