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:*