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Medical Questionnaire Form

Save time during your next medical questionnaire appointment. Complete your required form online from any device at any time before your visit.

Medical Questionnaire Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

CLICK HERE PDF FORM DOWNLOAD

Owner's Name *

First

Last

Pet’s Name *

Age

Weight

Date

Are you currently using a monthly heartworm preventive?

Yes
No

If yes, which one?

Last dose?

Have you seen any fleas on your pet?

Yes
No

What food are you feeding/how much

Do you provide at home dental care?

Yes
No

If yes, what type?

Do you have other pets?

Yes
No

If yes, what type?

Are your other pets current on their vaccines?

Yes
No

What is your pet’s outdoor exposure?

Daily walks/bathroom
50:50 Indoor/Outdoor
Strictly Indoor

What is your pet’s exposure to other pets?

Only housemates
When boarding/grooming
Dog Park/Training classes/day care
Strays/Wild Animals
No other exposure

Have you noticed any of the following about your pet since his/her last visit?

Coughing/labored breathing
limping
lethargy
Increased thirst/urination
Diarrhea/constipation
Vomitting
Red/squinty eyes/ocular discharge
Sneezing/nasal discharge
Itching

Does your pet have any behaviors you would like to change?

Yes
No

If yes, please explain

Have there been any changes in your pet’s environment?

Yes
No

If yes, please explain

What additional information does the staff need to know?

Name

REqUest aN Appointment

It is our privilege to serve the Murphy, Sachse, Wylie, and the surrounding communities. We look forward to seeing you and your pet! Request an appointment by clicking the button below.

Request Appointment

Murphy Veterinary Hospital

107 S. Murphy Road
Murphy, TX 75094

For general information, questions, appointment requests, call us at:

Phone: (972) 633-9999
Fax: (972) 633-8868
Email Us: murphy_vet@yahoo.com

HOURS

Monday: 8:00am – 6:00pm
Tuesday: 8:00am – 6:00pm
Wednesday: 8:00am – 6:00pm
Thursday: 8:00am – 6:00pm
Friday: 8:00am – 6:00pm
Saturday: 8:00am – 12:00pm
Sunday: Closed

Questions?

Get in touch! We look forward to hearing from you.

Name *

First

Last

Email *

Phone

How can we help you? *

Website

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