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South Dennis
Contact Buzzards Bay
508-759-5125
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(non-emergent)
Contact Dennis
508-398-7575
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Health History Form
Save time during your next appointment! Complete your health history form online from any device at any time before your visit.
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Online Forms
Health History
Form
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Select A Location
*
Buzzards Bay
Dennis
Owner Information
Name
*
First
Last
Email
*
Pet Information
Pet's Name
*
Have you owned your pet since he/she was a puppy/kitten?
*
Yes
No
If no, age of pet when obtained
Where did you obtain your pet?
*
Shelter
Pet store
Friend/Family
Private party
Is your pet’s Rabies vaccine current?
*
Yes
No
Is your pet’s Rabies vaccine current?
Has your pet traveled outside MA in the last few years?
*
Yes
No
If yes, where?
In the time that you’ve owned your pet has he/she ever...
had an allergic reaction?
*
Yes
No
If yes, describe which vaccine, drug, or other?
had a seizure?
*
Yes
No
If yes, when was the last seizure?
had a blood transfusion?
*
Yes
No
If yes, when?
been hospitalized?
*
Yes
No
If yes, for what condition?
had surgery aside from spay/neuter
*
Yes
No
If yes, for what condition?
had difficulty with anesthesia?
*
Yes
No
If yes, what was the problem?
been diagnosed with food sensitivities?
*
Yes
No
If yes, what restrictions should we keep in mind?
What is your pet’s current diet?
Is your pet on flea /tick preventative?
*
Yes
No
If yes, what brand(s)?
Is your pet on heartworm preventative?
*
Yes
No
If yes, what brand(s)?
Is your pet on any meds/supplements?
*
Yes
No
If yes, please list them
Has your pet received any over-the-counter medication such as aspirin, Pepcid, ibuprofen, Pepto Bismol or other drugs that you can buy in a pharmacy in the last week?
*
Yes
No
If yes, which drugs and when were they last given?
Has your pet had blood drawn for any tests in the last year?
*
Yes
No
Has your pet had x-rays of any kind in the last year?
*
Yes
No
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