Pre-Admit Checklist for clients

DentalVets Pre-admission Questionnaire

Please complete this questionnaire as accurately as possible. This will allow our Anaesthetist to plan your pet's anaesthesia protocol in advance of your visit.

Thank you

Please note, all fields on this form are required to be completed. If the question does not apply to you in the text boxes, please enter 'n/a' and move onto the next question.

 

Medication

1. Is your pet receiving any medication currently? :

Supplements

3. Does your pet take any supplements, herbal products or holistic therapies? :

Medicine Reactions

5. Has your pet had adverse reactions or problems to any previously prescribed medicine?:

Anaesthesia Recovery

7. If your pet has been previously anaesthetised, did you have any concerns regarding recovery?:

Anxiety

9. On a scale of 1 to 5 please indicate how anxious your pet is when visiting the vet:
10. Does your pet have anxiety related to travelling in the car?:
Select all that apply
11. Does your pet have specific triggers to display anxious behaviour? :
Select all that apply

Medical History

14. Does your pet have recent history of:
Select all that apply
15. Is your pet raw fed:
Security Question: