Patient Medical History Update in Reno, NV | Mountain View Animal Hospital & Holistic Pet Care

Name of person presenting pet:

First Last

Current Cell Phone Number:

Current Email:*

I am the:

Primary Owner
Other

Other:

My pets name is:*

First Last

My pet is a:*

Canine
Feline

My pet is:*

Mostly Indoors Only
Indoor / Outdoor
Outdoor Only
Goes to Grooming, Boarding and/or Daycare in the last 12 months or is expected to go.

Any past medical history or recent changes in medical history (major surgery / new diagnosis / chronic diseases / recent visits to emergency)

Yes
No

List any changes:*

Current Nutrition - At Mountain View Animal Hospital and Holistic Pet Care we believe in WHOLE BODY health which includes a nutritional assessment at least once a year. Good nutrition enhances pets' quality and quantity of life. Appropriate feeding throughout all life stages can help prevent diet-associated diseases, as well as to assist in the management of chronic illness. We recommend a follow up consultation with our nutritional counselor if any changes are recommended by the veterinarian after your exam. At that time, Lori will discuss your pets integrative nutritional needs.

Name, How Much, How Often:*

Current medication / supplements / preventatives / herbals? (please include medication name, dosage, etc.). This may include glucosamine supplements, heartworm prevention, chronic medications or other over the counter supplements.

EXAMPLE:

Med/Supplement Name: Metronidazole

Dosage (mg)(how often): 250 mg / twice a day

Last Given: 3/2/21

Travel history in the past or planned for the near future outside of Northern Nevada?

Yes
No

Location & Dates of travel:*

Any known Allergies to food / supplements / herbals in the past?

Yes
No

Please List Known Allergies:*