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Phone: 707-553-1400
Email: redwoodvet@yahoo.com
Pharmacy Refill Line: 707-647-4478
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Pet Medical History
Owner Name
*
First
Last
Email
*
Pet's Name
Species
*
Dog
Cat
CATS ONLY: Does your cat go outside of the house?
Yes
No
Color
*
Breed
*
Age of Pet
*
Gender
Female
Female/Spayed
Male
Male/Neutered
WHAT ARE WE SEEING YOUR PET FOR?
IF YOUR PET IS BEING SEEN FOR A MEDICAL CONCERN OR PROBLEM, HOW LONG HAS THIS BEEN GOING ON?
UNLESS DETAILED ABOVE, HAVE YOU NOTICED ANY RECENT CHANGES IN YOUR PET’S APPETITE, THIRST OR ENERGY LEVEL? PLEASE EXPLAIN:
UNLESS DETAILED IN ABOVE, HAVE YOU NOTICED ANY RECENT VOMITING, DIARRHEA, COUGHING OR SNEEZING BY YOUR PET? PLEASE EXPLAIN:
UNLESS DETAILED IN ABOVE, HAVE YOU NOTICED ANY RECENT CHANGE IN YOUR PET’S URINATION OR BOWEL HABITS? PLEASE EXPLAIN:
IF YOUR PET IS NOT FEELING WELL, ARE THERE ANY OTHER ANIMALS IN THE HOUSEHOLD SICK WITH SIMILAR SYMPTOMS?
HAS YOUR PET HAD ANY RECENT CONTACT WITH OTHER ANIMALS THAT ARE NOT PART OF YOUR HOUSEHOLD?
Yes
No
DOES YOUR PET HAVE ANY PAST, OR ONGOING MAJOR MEDICAL ISSUES?
THIS QUESTION IS FOR CATS ONLY: DOES YOUR CAT GO OUTSIDE OF THE HOUSE?
Yes
No
THIS QUESTION IS FOR CATS ONLY: DO ANY OTHER CATS IN THE HOUSEHOLD GO OUTSIDE OF YOUR HOUSE?
Yes
No
HAS YOUR PET EXPERIENCED ANY ADVERSE REACTIONS TO MEDICATIONS OR VACCINATIONS? IF SO, PLEASE EXPLAIN BELOW. PLEASE INCLUDE THE MEDICATIONS/VACCINES THAT CAUSED THE REACTION(S), WHAT THE REACTIONS LOOKED LIKE (GASTROINTESTINA/RESPIRATORY SIGNS, SWELLING, ETC.), AND THE APPROXIMATE DATE(S) OF THE REACTION(S).
CURRENTLY, DOES YOUR PET TAKE ANY MEDICATIONS (INCLUDING HEARTWORM PREVENTATIVES), SUPPLEMENTS OR EAT A PRESCRIPTION OR SPECIAL DIET? PLEASE EXPLAIN AND INCLUDE THE NAME, STRENGTH AND FREQUENCY OF DOSING OF ANY MEDICATION(S), IF POSSIBLE.
CURRENTLY, IS YOUR PET ON A FLEA/TICK CONTROL PRODUCT? PLEASE EXPLAIN
Vaccination History - DOGS
If your pet received its most recent vaccines from a hospital other than Redwood Veterinary Hospital, please provide approximate dates the vaccines were given below if possible:
DHPP (DISTEMPER, HEPATITIS, PARAINFLUENZA, PARVO)
Yes
No
Date
Date Format: MM slash DD slash YYYY
RABIES
Yes
No
Date
Date Format: MM slash DD slash YYYY
LEPTOSPIROSIS
Yes
No
Date
Date Format: MM slash DD slash YYYY
CANINE INFLUENZA
Yes
No
Date
Date Format: MM slash DD slash YYYY
Vaccination History - Cats
If your pet received its most recent vaccines from a hospital other than Redwood Veterinary Hospital, please provide approximate dates the vaccines were given below if possible:
FVRCP (UPPER RESPIRATORY VIRUSES, PANLEUKOPENIA)
Yes
No
Date
Date Format: MM slash DD slash YYYY
FELINE LEUKEMIA (FELV)
Yes
No
Date
Date Format: MM slash DD slash YYYY
Rabies
Yes
No
Date
Date Format: MM slash DD slash YYYY
If your pet has medical records at another hospital, kindly contact that hospital and ask them to forward your pet’s medical records (including vaccine history) to us at redwoodvet@yahoo.com. This will save you a lot of time and help us better understand your pet’s medical background.
DOES YOUR PET NEED ANY PRESCRIPTION MEDICATION REFILLS (PRESCRIPTIONS, HEARTWORM/PARASITE/FLEA-TICK CONTROL, ETC.)? PLEASE EXPLAIN:
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Home
About Us
Our Veterinarians
New Clients
Read Our Reviews
Take A Tour
Payment Options
Promotions
Employment Opportunities
Resources
Forms
Online Forms for Existing Clients
New Client Forms
Essays for Pet Owners
Links
Puppy and Kitten Care
Senior Pet Care
Employee Login
Services
Wellness Care
Pet Diagnostics
Pet Dental Care
Veterinary Surgery
Pet Weight Loss
Pet Loss
Pet Health
Pet Health Library
Pet Insurance
How-To Videos
Pet Health Checker
Pet Food Recalls
Product Recalls
News
Blog
Pet Portal
Pet Records
Request a Refill
Online Pharmacy
Contact Us
Schedule an Appointment
Forms
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