Patient History
Patient's Name
What was your pet referred for
Have x-rays been taken?
Does your pet have any major medical problems? (If yes, please list)
Is your pet on any medications?
Yes
No
If yes, please list
Name
Dose
Frequency
Name
Dose
Frequency
Name
Dose
Frequency
Name
Dose
Frequency
Is your pet allergic to any medication, food, or treats?
Does your pet have a history of anesthesia complications?
Has your pet had any advanced dental work done in the past?
When was your pet’s last dental cleaning?
What is your pet’s current diet?
Does your pet have access to any of the following:
Natural Bones
Nylon Bones
Tennis Balls
Frisbees
Rope Toys
Sticks
Hooves
Rawhides
Pig Ears
Antlers
Ice Cubes
Other Chew Toys