Vaccination & Preventive Care Questionnaire
Please fill this out before your visit. It takes about 3-5 minutes.
🐾 PET INFORMATION
🐶 DOG HEALTH QUESTIONNAIRE
1How old is your dog?
2Does your dog have any prior vaccination history?
Which has your dog already received elsewhere? Check all that apply - your vet will confirm against records.
3If vaccinated before, has your dog ever had a negative reaction to a vaccine?
⚠️ Please alert the veterinarian before proceeding - a prior vaccine reaction was reported.
4Is your dog currently sick or recovering from an illness?
⚠️ Please alert the veterinarian - your dog may not be suitable for vaccination today.
5Is your dog pregnant or going to be bred soon?
⚠️ Please alert the veterinarian - some vaccines are not recommended during pregnancy or pre-breeding.
6Is your dog primarily indoor, outdoor, or both?
7Do you live in an area where flooding is common?
8Does your dog go to the beach, natural water sources, or play in puddles?
9Is your dog regularly exposed to other dogs? (includes boarding, daycare, dog parks, grooming, household dogs)
10Do you travel regularly with your dog?
11Do you live in or travel to areas where wildlife (raccoons, opossums, rodents) are common?
12Do you take your dog hiking, hunting, or into wooded areas?
13Do you live in or travel to areas where rattlesnakes may be present?
14Do you feed your dog raw meat?
15Does your dog regularly receive parasite preventives?
16Which parasite preventives does your dog currently receive?
17Do you live in or travel to areas where mosquitoes are common?
18Do you live in or travel to areas where ticks and fleas are common?
19Has your dog ever tested positive for heartworm?
20Has your dog ever tested positive for intestinal worms?
21Does your dog stay at boarding/kennels, attend daycare or grooming, or go to dog shows or group events? (canine influenza risk)
🐱 CAT HEALTH QUESTIONNAIRE
1How old is your cat?
2Does your cat have any prior vaccination history?
Which has your cat already received elsewhere? Check all that apply - your vet will confirm against records.
3Has your cat ever had a vaccination reaction?
⚠️ Please alert the veterinarian - a prior vaccine reaction was reported.
4Is your cat currently sick or recovering from an illness?
⚠️ Please alert the veterinarian - your cat may not be suitable for vaccination today.
5Is your cat pregnant or intended for breeding?
⚠️ Please alert the veterinarian - some vaccines are not recommended during pregnancy or pre-breeding.
6Is your cat primarily indoor, outdoor, or both?
7Do you live in an area where flooding is common?
8Does your cat have access to outdoor water sources (puddles, canals, etc.)?
9Is your cat regularly exposed to other cats? (boarding, grooming, multi-cat household, friends/family cats)
10Are wildlife, rodents, or birds common in your area?
11Do you travel regularly with your cat?
12Does your cat roam outdoors or hunt?
13Do you feed your cat raw meat?
14What parasite preventives does your cat currently receive?
15Are mosquitoes common in your area?
16Are fleas and ticks common in your area?
17Has your cat ever tested positive for heartworm?
18Has your cat ever tested positive for intestinal parasites?