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7300 Ranch Rd 2222 Bldg 5, Suite 100, Austin, TX 78730
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Emergency Hours:
24/7/365
Specialty Hours*:
M – Sat: 8am – 6pm
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Neurology & Neurosurgery Patient Medical History
Austin Veterinary Team
2020-03-17T13:49:47-05:00
Neurology & Neurosurgery Patient Medical History
Pet Name:
Owner First and Last Name:
Date:
MM slash DD slash YYYY
How long have you owned your pet?
Where was your pet obtained?
Has your pet traveled out of state in the past two years?
Yes
No
Unknown
Where has your pet traveled out of state in the last two years?
Has your pet ever had ticks?
Yes
No
Unknown
When did your pet have ticks?
Is your pet kept primarily outdoors or in the house?
Are there any other pets in your household?
Yes
No
What other pets are in your household?
What is your pet's diet?
How much and how often do you feed?
Is your pet ever fed table food?
Yes
No
Has your pet been boarded or hospitalized recently?
Yes
No
Unknown
Has your pet been treated for any major medical problems?
Yes
No
When and what major medical problems was your pet treated for?
If your pet is neutered, what was his/her age at alteration?
If female and not neutered, when was her last heat?
If female, has she had any litters?
Yes
No
Unknown
When did your pet have litters?
Has there been a change in your pet's appetite?
Yes
No
Unknown
How has your pet's appetite changed:
Increased
Decreased
Has there been a recent change in your pet's weight?
Yes
No
Unknown
How has your pet's weight changed?
Increased
Decreased
Has there been a change in your pet's water consumption?
Yes
No
Unknown
How has your pet's water consumption changed?
Increased
Decreased
Is your pet urinating more frequently than normal?
Yes
No
Unknown
Has your pet been straining to urinate?
Yes
No
Unknown
Have you noticed your pet vomiting?
Yes
No
Unknown
What is the frequency of your pet's vomiting?
Has there been a change in your pet’s bowel movements?
Yes
No
Unknown
Please describe the appearance (color and consistency):
What is the frequency of defecation?
Has there been any straining to defecate?
Yes
No
Unknown
Have you seen any blood in any urine, vomitus, or stool?
Yes
No
Unknown
Has your pet been scratching?
Yes
No
Unknown
Has your pet had any seizures or convulsions?
Yes
No
Unknown
Has there been a change in your pet’s attitude or behavior?
Yes
No
Unknown
Please describe the changes in your pet’s attitude or behavior.
Has there been any change in your pet’s walking?
Yes
No
Unknown
Has your pet lost any stamina lately?
Yes
No
Unknown
Have you noticed any abnormal swellings?
Yes
No
Unknown
Where have you noticed abnormal swellings?
Have you noticed any abnormal discharges or drainage?
Yes
No
Unknown
Please describe the abnormal discharges or drainage (eyes, nose, vulva; appearance):
Has your pet had difficulty breathing?
Yes
No
Unknown
Has your pet had any coughing?
Yes
No
Unknown
How often does is your pet cough?
Occasional
Frequent
Continuous
When does your pet's coughing occur?
Night
Morning
Exercise
Excitement
Anytime
How would you describe your pet's cough?
Mild
Moderate
Severe
Has your pet had any unexpected reactions to medications?
Yes
No
Unknown
Has your pet received aspirin or Ascriptin during the past six months?
Yes
No
Unknown
Is your pet currently receiving medications?
Yes
No
Unknown
What medication is your pet currently receiving? Please provide the name and dosage.
Describe your primary concern(s) about your pet.
When did this problem(s) begin?
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Our Team
News
Events
Join Our Team
COVID-19 Updates
EMERGENCY
SPECIALTIES
â–¼
Anesthesiology
Cardiology
Critical Care
Diagnostic Imaging
Internal Medicine
Neurology & Neurosurgery
Oncology
Surgery & Orthopedics
PET OWNERS
â–¼
Pay Online
Testimonials
FAQ
Forms
Financing
VETERINARIANS
â–¼
Referring Veterinarian Partners
Continuing Education
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