Skip to content
Save $100 off your Dog’s Next Dental Service with Our Dental Days Promo
book now
24/7 Wellness Services
Emergency Pet Care
Pet Wellness
Pet Vaccinations
Spay/Neuter
Pet Teeth Cleaning
Parasite Prevention
Pet Surgery
Pet Euthanasia
Pet Medical Services
About
Contact
Our Veterinarians
Pet Insurance & Payment Options
Boarding
The Barkstone
The Pet Lodge
Check On Your Pet
Other Services
Dog Daycare
Dog Grooming
Current Clients
New Clients
Forms
Veterinary Blog in Keller, TX
24/7 Emergency
24/7 Wellness Services
Emergency Pet Care
Pet Wellness
Pet Vaccinations
Spay/Neuter
Pet Teeth Cleaning
Parasite Prevention
Pet Surgery
Pet Euthanasia
Pet Medical Services
About
Contact
Our Veterinarians
Pet Insurance & Payment Options
Boarding
The Barkstone
The Pet Lodge
Check On Your Pet
Other Services
Dog Daycare
Dog Grooming
Current Clients
New Clients
Forms
Veterinary Blog in Keller, TX
24/7 Emergency
BOOK APPOINTMENT
Pet Health Questionnaire
Pet Health Questionnaire
Client Information
Your Full Name
*
Phone
*
Email
*
Has your address changed recently?
*
Yes
No
New Address
City
Zip
Pet Information
Pet Name
*
Cat/Dog
*
Cat
Dog
About Your Pet
Please check the significant problems that apply to your pet:
Coughing
Itching Skin
Difficulty Breathing
Lethargic
Losing Weight
Vomiting
Limping
Difficulty Defecating
Eye Discharge
Nose discharge
Shaking Head
Scratching Ears
Having Seizures
Sneezing
Other
How many times per day is your pet vomiting?
How times times per Day/Week/Month is your pet experiencing seizures?
Please indicate whether your pet is limping front/back and left/right.
Front
Back
Left
Right
Please describe in detail the issues or symptoms your pet is experiencing, including the duration and frequency, and whether any home remedies have been tried:
Describe your pet’s appetite and drinking habits:
Describe your pet’s urine and bowel habit:
No Change
Increased Urine
Increased Stool
Formed Stool
Semi-Formed Stool
Watery Stool
What are you currently feeding your pet?
Dry Food
Canned Food
What brand of dry food are you feeding them?
What brand of canned food are you feeding them?
Has your pet recently eaten anything that is not pet food (i.e. people food, treats)?
Have you recently changed their diet?
Yes
No
What were you feeding them previously?
Where does your pet spend his/her time?
Only Indoor (never outside)
Mainly Indoor
Mainly Outdoor
Equally Indoor/Outdoor
Is your pet currently receiving a monthly flea and/or heartworm prevention?
Yes
No
What kind and day of the month does your pet receive their prevention medicine?
Is your pet currently receiving any other medications or supplements? Please list medications/supplements and dosages.
Please list any other comments or questions you have for the doctor.
If Creekside Pet Care is not your primary veterinary clinic, please list your vet:
Captcha
If you are human, leave this field blank.
Submit
Get the best care for your best friend.
Walk-in or book an appointment online
BOOK APPOINTMENT
Please ensure Javascript is enabled for purposes of
website accessibility
