Name: Ilderton Pet Hospital
Address: 125 King St, Ilderton, ON, NOM2A0
Telephone: +1-(519) 666-2288
Price range: $$

We are excited to have your pet coming in for their annual exam. In order to ensure the best care and make your visit as smooth and informative as possible, we ask that you fill out this form ahead of your appointment.

Client Name*
Patient Name*
Email*
Is your pet nervous when they come to the hospital? Our staff have been trained in Fear Free techniques and we have ways to help.
(For cats) Is your cat indoors only or indoor/outdoor? Do they have contact with wildlife or other outdoor pets?
(For dogs) Does your dog go to the dog park, groomer or a boarding facility or have social time with dogs from other households?
(For dogs) Does your dog tend to drink from an outdoor water source (ponds/puddles) or have access to wildlife areas or nature trails?
Do you have any recent health concerns for your pet?
Have there been any behaviour changes which you have noticed?
What diet does your pet eat, how much and how often? Please include any treats, supplements and human food.
Have there been any recent changes in appetite or thirst?
Have there been any changes with your pet's urination or stools?
Any coughing or sneezing?
Any vomiting or diarrhea?
Any new lumps or bumps?
Any lameness or mobility concerns?
Is your pet is on any medication? What type of medication? What is the dose and frequency your pet is currently receiving? Do you need any refills for your medication(s)?
Are there any additional procedures you would like to request with your appointment?
***Parasites can pose a human health risk. We recommend bringing a fresh (within 24 hours) fecal sample to check for internal parasites every year or more frequently if there are any digestive concerns or high risk for parasite exposure. ***

We thank you for taking the time to fill out this form and we look forward to seeing you and your companion soon.
Phone
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Annual Wellness Pre-Visit Questionnaire

Mailing Address

Office Hours

Monday	8:30am – 5:00pm
Tuesday	8:30am – 5:00pm
Wednesday	8:30am – 5:00pm
Thursday	8:30am – 5:00pm
Friday	8:30am – 5:00pm
Saturday	8:30am – 12:00pm
Sunday	Closed