Annual Exam Questions

Name: Plaistow-Kingston Animal Medical Center
Address: 48 Route 125, Kingston, NH, 03848, United States
Telephone: 603-642-9700
Price range: $

Is your pet coming in for an annual exam? You can fill out this annual exam form and securely online by filling in the form below.

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Annual Exam Questions Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 603-642-9700 for a faster response.

The following questions will evaluate your pet's general health concerns. Check off all that apply.

Patient Annual Exam Questions

Client's Name *

First

Last

Email *

Patient's Name *

Species *

Current medical problems?

Previous medical problems?

Any previous veterinary visits?

Nutraceuticals your pet is currently on? Name / Dose / Frequency?

Common Nutraceuticals are Vitamins, Minerals, Probiotics, Omega Fatty Acids, Glucosamine, etc

Other medications your pet is currently on? Name / Dose / Frequency?

Current Diet (Food Brand and Amount/Day(s) Fed)

Do you give treats or human food?

The following questions will evaluate your pet's general health concerns. Check off all that apply.

Any decreased activity / lethargy or weakness?

Any excess eye discharge / redness?

Any head shaking, ear redness / discharge / odor?

Any nasal discharge / sneezing / gagging / coughing?

Any excessive thirst or urine output?

Any changes in appetite / vomiting / diarrhea?

Any stiffness / limping / back or limb pain?

Any itching / scratching, hair loss?

Any lumps or swellings?

Do you have any other concerns?

Upload Pet's Photo

Click or drag a file to this area to upload.

Accepted file types: jpg, gif, png, pdf.

Request an Appointment

Is your pet due for a checkup? Have a concern? We pledge to provide compassionate and professional care to pets in Kingston, NH and beyond. If this is a pet emergency, please call (603) 642-9700 or visit Port City Veterinary Referral Hospital - IVG (603-433-0056).

Appointment

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