Pre-Consultation Questionnaire Posted on January 28, 2021January 28, 2021 by Cheshire Required Fields Are Marked [*] Please call the office to set up a consultation prior to completing this formThank you so much for taking the time to fill the medical information for your pet. The information you provide below along with your pet’s medical records from your referring veterinarian office will help us to facilitate a thorough oral examination and provide you with our recommendations based on these findings.The day of your consultation Please arrive 10 minutes prior to your appointment time. When you arrive please text or call the office at 503-292-4533 to let us know you are here. A Veterinary Technician will call you to review your responses, confer with the doctor before coming out to get your pet. Once the examination is completed, the doctor will call you to discuss the findings and recommendations for your pet. We will then provide you with a treatment plan(s) with the estimated cost. If no further tests are needed and you wish to proceed with the recommendations, we can schedule your pets surgery based on the treatment plan provided. Date Completed:* Date Format: MM slash DD slash YYYY Owners Name:* First Last Owners Email:* Pet's Name:*Best Phone to reach you if we have further questions prior to your pet's visit:*What is the reason your pet was referred to the Animal Dental Clinic?*Who is your primary care veterinarian and at which hospital are they referring from?*Does your pet see any veterinary specialist for advanced veterinary care?*YesNoIf yes please list all specialists your pet has seen or still under their care.When did you first notice your pet’s dental/oral condition?*Is your pet showing any signs of pain or discomfort? (pawing at face, rubbing face, only chewing on one side of the face, dropping food, etc.)*YesNoIf yes please describe what you have noticed.Is your pet on pain medications or antibiotics for this dental condition.*YesNoIf Yes Have those medications helped?Do you currently have a dental homecare regiment for your pet? If so, please explain what you are doing and what products you use.*How many dental cleaning procedures has your pet had over its lifetime under general anesthesia?*When was the most recent dental cleaning procedure?*Did your pet have any dental treatments (surgical extractions) at that time?*YesNoIs your pet eating and drinking well?*YesNoWhat does your pet eat? (check all that apply)* Kibble Wet Food Raw Food Grain Free Does your pet have any food allergies?*YesNoIf so, please explain what they are allergic to and what diet they are currently eating.Does your pet play with toys?*YesNoIf Yes what kind of toys does he/she enjoy playing with or chewing on?Has your pet recently had any unusual Coughing, Sneezing or Vomiting?*YesNoIf yes, to any of these questions please tell describe for how long and if they have recently been treated for it?Has your pet recently had any Diarrhea?*YesNoIf yes, is your pet currently being seen for this condition?YesNoPlease list all current medications & supplements: (Please include the dose)*Does your pet have any chronic health conditions such as a heart murmur, Thyroid disease, kidney disease, autoimmune disease, diabetes etc.?*YesNoIf yes please list the conditions.When was your pet’s last comprehensive blood panel completed?*If it was done at a clinic other than your primary care clinic, please list the name of the clinic so we can request a copy of those results.You must click on the Submit button below after you verify the Captcha code.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.