Medications (concentration and frequency)
Diet (brand, amount per day)
Supplements (brand, amount per day)
Reason for visit
If Abnormal, describe
Cool or warm preference
Express Additional Concerns
Other medical history (please include approximate dates of diagnosis)
Does your pet enjoy being in the water/swimming?
Do you have access to a swimming pool?
What aggravates the problem?
What eases the problem?
Is the problem/pain affected by time of day or activity?
If yes, please explain:
May your pet receive small treats during his/her visit? (If not, please bring appropriate treats for your pet.)
What specific goals do you have for your pet? (For example: climb up 4 steps to the front door with minimal assistance, resume 30-minute jogs with me, return to competitive agility)
Periodically, JPESC will take photographs of our patients for positive promotional purposes for the clinic that may include images/stories for our website, hard print, and social media sites. By initializing, you authorize us to use your pet's images for such promotion at our discretion.
I consent for any reviews or testimonials for JPESC that I post online to be reshared on the JPESC website and other social media platforms for JPESC marketing purposes.