History Form for Vomiting or DiarrheaOwner Name* First Last Pet's Name*Please fill out this form by 9 am the day of the appointment. What diet is your pet currently on? Has it changed recently?*How is your pet’s appetite? Not eating, decreased, normal or increased?*How is your pet’s activity? Normal or decreased?*Does your pet get any human food, table scraps, bones, or treats? If yes, please list.*Does your pet tend to chew on things such as toys, clothing, string, hair ties, rope, raw hides etc.?*Any exposure to toxins (rat poison, antifreeze, chocolate, grapes, etc. ) , plants, human medication, recreational drugs,etcWhen did the symptoms start? Is it vomiting, diarrhea or both?*If your pet is vomiting/diarrhea, how many times/frequency & most recent vomit/diarrhea?*If vomiting, what does the vomit consist of? (clear/foamy, bile (yellow liquid), blood, digested or undigested food, hair)?*If diarrhea, describe the stools- normal, soft, liquid, mucus, blood, pale or dark/black.If your pet is having diarrhea, are they having accidents in the house?Has there been anything new or stressful (recently kenneled, home remodel, recent travel, new people or pets to the household)?Please list any medications your pet is taking including supplements, heartworm, flea and tick medicationIf your pet is a new patient to us or has had veterinary care elsewhere, please provide records/dates for previous vaccinations, dewormer, heartworm test and fecal parasite test. Also list any diagnosed underlying medical conditions.For cats Indoor only Indoor/Outdoor Outdoor only ***Please bring stool sample if possible*** (Within the last 24 hrs)***Please do not feed your pet the day of the appointment in case we determine an x-ray or blood tests are needed*** (Exception to this would be for a diabetic patient)
