Patient information questionnaire We endeavour to make your pet’s stay with us as comfortable as possible. To help us care for them, we would be grateful if you can complete this short questionnaire and bring it to your appointment. Please tick all boxes that apply.Your Surname(Required)Is your pet a Dog or Cat(Required)DogCatDogDog's nameWhat is your dog’s temperament? Placid Friendly Nervous Excitable What does your dog usually wear on a walk? Collar & Lead Harness Other How does your dog behave when being walked on a lead? Calm Strong Pulls on lead Does your dog have mobility problems? Yes No If yes, what?Is your dog in season? Yes No Not applicable Dog – OriginWas your dog born in the UK?(Required) Yes No Unsure Please specify country of origin:(Required)Dog – Travel HistoryHas your dog ever travelled outside the UK?(Required) Yes No Unsure Country/countries visited:(Required)Dates of travel (approximate if unsure):(Required)Dog – Breeding & Reproductive HistoryHas your dog ever been used for breeding (e.g. mated or produced/carried a litter)?(Required) Yes No Unsure Dates or approximate timing:(Required)Location (UK or abroad):(Required)Dog – Additional InformationDoes your dog live with, or have regular close contact with, other dogs that have travelled abroad or been imported?(Required) Yes No Unsure CatCat's nameWhat is your cat’s temperament? Placid Friendly Nervous Other Where does your cat spend time? Indoors only Indoors & Ourdoors Outdoors only If outdoors, how far does your cat go? Free roaming Garden only Is your cat friendly to other cats? Yes No Sometimes Does your cat have mobility problems? Yes No If yes, what?MedicationIs your pet on any medication?(Required) Yes No MedicationName of medicationDoseTimes per dayTime of day Add RemoveFeedingFood(Required)Type of FoodQuantityTime Add RemoveIs your pet on a specific diet? Please explain why:What snacks/tit-bits does your pet get?How would you describe your pets appetite when well? Poor Fussy Normal Greedy Ravenous Do you usually give your pet oral medications in food? Yes No If yes, what food?Any known allergies? Yes No If yes, please state?Urination / DefaecationWhere does your dog usually urinate? E.g. GrassDoes your cat use a litter tray? Yes No What type of car litter do you use? Clay based granules Wood pellets Starch Granules Paper Does your dog usually toilet on a lead? Yes No Usual toileting commands:Does your pet usually suffer from any urination/defaecation problems? Yes No If yes, what is the condition?BehaviourDoes your cat get upset by other cats? Yes No Sometimes Does your dog get along with other dogs? Yes No Sometimes Is your pet aggressive with people? Yes No Is there anything else you would like our team to know about your pet?