Canine Annual Wellness Pre-Exam History Form Name* First Last Pet's Name*Phone*Have there been any changes to your dog’s behavior since his/her last wellness exam? Does your pet have any specific anxiety or phobia concerns?*What brand of food do you feed your dog and how much volume of that food does your dog eat per day?*Any special treats your dog receives on a routine basis?*Have there been any changes to your dog’s eating or drinking habits?*Is your dog urinating and defecating normally without any pain or discomfort?*YesNoIs your dog urinating more than normal or in abnormal locations?*YesNoHas your pet had any vomiting or diarrhea recently? Does your pet have any history of consistent vomiting/diarrhea from time to time? If so, how often, on average?*Has your dog been exhibiting any coughing, sneezing you are concerned about?*YesNoIs there any abnormal eye discharge that you have noted?*YesNoDoes your dog have any occasional or continual limping you have noted?*YesNoIs your pet itchy, shaking his/her ears, or have any skin concerns today?*YesNoHave you noted any new lumps or bumps on your pet you are worried about? Any previously discussed lumps that are changing significantly since the last wellness exam?*YesNoPlease indicate which products your dog receives for routine heartworm prevention as well as flea and tick control. Please also note whether you give these products continually (i.e. monthly), or if not, which months your dog is not receiving these products.Is your dog on any other prescription medications or supplements? If so, please list each medication you administer.