Pre Consultation Questionnaire | Kohi Veterinary Clinic

Full name

Email address

Phone number

Address

Pets name

What is the primary reason you are seeking medical advice today? Please be as descriptive as possible

If this reason above is to check a 'lump' please describe exactly where the lump is, how many there are and what size they are.

Does your pet have any other problems that are concerning you?

How long has your pet had this primary problem?

Was the onset of signs rapid, gradual or intermittent?RapidGradualIntermittent

Has the problem improved, worsened or not changed over time?ImprovedWorsenedNot changed

Has a similar problem happened in the past?YesNo

Have you sought advice from another clinic for this problem?YesNo

Have any medications and/or treatments been administered for this problem? And what effect did they have?

Has there been a change in attitude or behaviour in your pet with this problem? If so, how?YesNo

If you selected yes above please explain with as much detail as possible.

Has the problem affected your pets ability to exercise and by how much?

How is your pets appetite? Increased, decreased or normal?IncreasedDecreasedNormal

What is your pets current diet.

What snacks or treats do they have?

How often are they fed?

Have you noticed an increase or decrease in weight?IncreaseDecreaseNo change

Has your pet had any vomiting or diarrhoea?VomitingDiarrhoeaNo change

If your pet has one of the symptoms described in the previous question please describe how often this occurs. How many times a day?

Any change in water consumption? Increased or decreased?IncreasedDecreasedNo change

Any change in urine habits? For example, frequency, straining/difficulty, colour, odour, spraying/marking or ‘accidents’.

When was your pet last treated for fleas and with what?

Are you giving your pet any other supplements or medication?

PRE CONSULTATION QUESTIONAIRE