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Veterinarians in Lebanon, New Hampshire | Stonecliff Animal Clinic
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Outpatient Medical History
Home
» Outpatient Medical History
Outpatient Medical History
Name
First
Last
Phone
Date
Date Format: MM slash DD slash YYYY
Email
Pet's Name
*
First
Type of Pet
Dog
Cat
Pocket Pet
Describe your concern/reason for visit:
*
How long has this been going on for?
*
Days
Weeks
Months
What are you currently feeding your pet?
*
How is their appetite?
*
Poor
Good
Excellent
When did they last eat?
*
Have you changed their diet recently?
*
If you answered yes to last question, how long ago?
Are you currently giving any medications or supplements? If so name/dose/date last give?
Any coughing or sneezing?
*
Yes
No
Third Choice
Any vomiting or diarrhea?
*
Yes
No
Third Choice
Have they gotten into anything? Eaten anything different or unusual?
*
Any household changes?
How is their behavior?
*
Lethargic
Normal
Hyperactive
Any changes in thirst?
*
Increased
Normal
Decreased
How are their bowel movements
*
Normal
Abnormal
Third Choice
When was their last bowel movement?
*
Any changes in Urination?
*
Increased
Normal
Decreased
Would you like to accompany your pet into SAC for their visit today or chat via telephone?
*
Accompany pet into exam room
Video Chat
Third Choice
Is there anything else that you can tell us about your pet that you feel is important for this visit?
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Services
Pet Health Library
Location Hours
Monday
8:00am – 7:00pm
Tuesday
8:00am – 7:00pm
Wednesday
8:00am – 7:00pm
Thursday
8:00am – 5:00pm
Friday
8:00am – 5:00pm
Saturday
8:00am – 5:00pm
Sunday
Closed
New Winter Hours: Closed Sunday