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info@vavetderm.com

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Canine Recheck Exam Form

Completing the form below gives our dedicated veterinary team the insights they need to provide the best care possible.

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Canine Recheck Exam Form

Regular check-ups are essential in maintaining your canine companion’s happiness and health. Don’t wait – take a moment to fill out the form below today, and let’s keep those tails wagging with joy!

You can download the form to your computer by clicking the button below. Open and complete the form. Then save and rename a copy of the completed form on your computer with your pet’s name.
Then you may attach your completed copy of the form to an email and send it to info@vavetderm.com.

Download the form (pdf)

Client Name *

First

Last

Date *

Email *

Patient Name

Have you noticed any issues/problems with your pet? Are there any concerns for the following: (check all that apply)

Scratching
Licking/Chewing
Hair Loss
Body Odor
Lesions
Head Shaking
Scooting
Gas/Flatulence
Vomiting
Diarrhea
Change in appetite
Change in water intake
Urination Change
Energy Level

If scratching, where, how often and when first noticed?

If licking/chewing, where, how often and when first noticed?

If hair loss, where, how often and when first noticed?

If body odor, where, how often and when first noticed?

If lesions, where, how often and when first noticed?

If head shaking, occuring/changes, how often and when first noticed?

If scooting, occuring/changes, how often and when first noticed?

If gas/flatulence, occuring/changes, how often and when first noticed?

If vomiting, occuring/changes, how often and when first noticed?

If diarrhea, occuring/changes, how often and when first noticed?

If change in appetite, occuring/changes, how often and when first noticed?

If change in water intake, occuring/changes, how often and when first noticed?

If urination change, occuring/changes, how often and when first noticed?

If energy level, occuring/changes, how often and when first noticed?

Current itch level

Itch Level Scale 0 (none) to 10 being the worst (can not walk across the room without stopping to itch)

Pervious itch level

Owner's perception of progress

Concerns

Name of medication/quantity in mg/amount given/am pm/How much left?/Do you need more/How much?

Cytopoint

Did it help?

How quickly?

Repeat?

Ear meds at home

How often/last/refills

Ear cleaner

How often/last/refills

Shampoo

How often/last/refills

Heartworm prevention

How often/last/refills

Flea/tick prevention

How often/last/refills

Allergy serum: INJ / SL

How often/last/refills

Any problems BEFORE or AFTER allergy serum?

How often/last/refills

Does bathing help/how long?

What brand and type of food do you feed your pet?

Brand/Dry
Brand/Canned
Treats
Table Food
Pills
Forbidden Food

If brand/dry, explain

If brand/canned, explain

If treats, explain

If table food, explain

If pills, explain

If forbidden food, explain

Any problems?

When did your pet last eat/drink?

Name

READY TO VISIT US?

Visit Veterinary Dermatology of Richmond

We serve the pets of Richmond, Midlothian, Mechanicville, Henrico, Goochland, Charlottesville, Stafford, Woodbridge, Williamsburg, Zions Cross Roads, and the surrounding areas. We look forward to seeing you and your pet.

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Questions?

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

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Location

13815 Fribble Way
Midlothian, VA 23112

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Contact

Phone: 804-740-9555
Fax: 804-740-5002
Email: info@vavetderm.com

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Hours

Monday-Friday: 8am – 5pm
Saturday-Sunday: Closed
Closed daily from 12:15pm – 12:45pm