Female Intact
Female Spayed
Male Intact
Male Neutered
Breeder
Pet Store
Friend
Stray
Humane Society
Other
Indoor
Outdoor
Both
Normal
Happy-Active-Normal
Depressed-Lethargic
Normally
More
Less than usual
Limping
Eye Discharge
Nasal Discharge
Sneezing
Coughing
Shaking Head
Scooting
Scratching
Vomiting
Diarrhea
Lumps
Bad Breath Often
Weightloss
Lethargy / Weakness
Seizures
Hair Loss
Pain or Straining when Urinating / Defecating
Yes
No
First visit to a veterinarian
Physical exam
Dental exam
Dental cleaning
Heartworm test
Fecal sample test
Blood testing for kidney and liver function
Deworming performed
Rabies
Canine Distemper
Lyme Disease
Kennel Cough (Bordetella)
Canine Influenza
