Javascript must be enabled for the correct page display
Click Here To Become a New Client
Hours & Contact
(920) 269-4072
[email protected]
facebook
instagram
twitter
youtube
google
Main Menu
Menu
Services
Cat Services
Kitten Care
Cat Declawing
Cat Dental
Cat Dermatology & Allergies
Cat Diagnostic Imaging
Cat Euthanasia
Cat Fleas & Ticks
Cat Heartworms
Cat Lab Tests
Cat Laser Therapy
Cat Microchipping
Cat Pain Management
Cat Preventative Care
Cat Senior Care
Cat Spaying and Neutering
Cat Surgery
Cat Vaccinations
Cat Wellness Exams
Dog Services
Puppy Care
Dog BAER Hearing Tests
Dog Dental Care
Dog Dermatology & Allergies
Dog Diagnostic Imaging
Dog Ear Cropping
Dog Euthanasia
Dog Fleas & Ticks
Dog Heartworms
Dog Lab Tests
Dog Laser Therapy
Dog Microchipping
Dog Neutering or Vasectomy
Dog Pain Management
Dog Preventive Care
Dog Reproduction
Dog Senior Care
Dog Spaying Or Ovary Sparing Spay
Dog Surgery
Dog Taurine Testing
Dog Vaccinations
Dog Wellness Exams
Dogosterone Therapy
Surgery
Puppy Training Classes
Reproduction
Important Considerations for Breeding
Breeder's Library
BAER Hearing Test
Dog Reproduction FAQ
Ear Cropping
Progesterone Testing
Semen Collection and Freezing
Spay & Neuter Controversy
About Us
Meet the Team
Veterinarians
Team Members
Preparing for a Vet Visit
Careers
Photo Gallery
Hospital Tour
In The News
Our Videos
Events
2025 Dairyland Classic - Pedigrees To Pups Seminar
2025 Island Time - Pedigrees To Pups Seminar
Annual Breeders Health Clinic
Pink Paw Program
Our Family Of Practices
Resources
Blog
Forms
Helpful Links
Chicago's Pet Friendly Resources
Waukegan's Pet Friendly Resources
Partners
Podcasts
Puppy Breeder Referral
Double G's Pembroke Welsh Corgis and Danish Swedish Farmdogs
Breed Information Library
Cats
Dogs
Preparing for a Vet Visit
Bravecto and Sentinel Instant Rebates
Spay and Neuter Controversy
Breeders Library
Pet Health Library
CDC Travel Guidelines For Dogs
Canine Infectious Respiratory Disease Complex
Dr. Greer 2024 Speaking Schedule
Poisons Guide
Symptom Checker
Veterinary Care Foundation
Store
Pet Portal
Request an Appointment
Search
Button Bar
New Patient Center
Online Store
Symptom Checker
Information about your healthy pet for today’s appointment
Your Name
Your Pet’s Name
Date
Best way to reach you?
- None -
Phone
Email
List Times Available and Times
Home
Time
Cell
Time
Work
Time
Email
How do you prefer we report your pet’s fecal & heartworm tests to you?
- None -
Phone
Mail
Email
How do you prefer to receive other communications from doctors and staff?
- None -
Phone
Mail
Email
Overall Health
Does your pet have any allergies to food, vaccines, or medications?
- None -
Yes
No
If yes, please describe
PLEASE MARK ANY SYMPTOMS OR CONCERNS YOU HAVE ABOUT YOUR PET’S HEALTH TODAY.
Concerned or Changes
Is your pet under the care of another veterinarian or health care professional?
- None -
Yes
No
Comments
Is your pet on medications or supplements?
- None -
Yes
No
Comments
What do you feed your pet? *
Yes
No
Comments
What treats do you give your pet?
- None -
Yes
No
Comments
Changes in eating/ appetite?
- None -
Yes
No
Comments
Diet change in the past month?
- None -
Yes
No
Comments
Weight change?
- None -
Yes
No
Comments
Changes in drinking/water consumption
- None -
Yes
No
Comments
Changes in urination?
- None -
Yes
No
Comments
Skin changes/itching/rash/lumps?
- None -
Yes
No
Comments
Eyes redness/squinting/discharge/ vision change?
- None -
Yes
No
Comments
Ears/head shaking/scratching/odor?
- None -
Yes
No
Comments
Breathing/coughing/sneezing/gagging?
- None -
Yes
No
Comments
Teeth/gums/breath odor?
- None -
Yes
No
Comments
Legs or back/pain/arthritis?
- None -
Yes
No
Comments
Vomiting?
- None -
Yes
No
Comments
Normal stools?
- None -
Yes
No
Comments
Housebreaking concerns?
- None -
Yes
No
Comments
Spayed or neutered?
- None -
Yes
No
Comments
Changes with reproductive organs?
- None -
Yes
No
Comments
Scooting?
- None -
Yes
No
Comments
Attitude or behavior changes?
- None -
Yes
No
Comments
Other?
- None -
Yes
No
Comments
Todays Visit
Is your pet current on vaccinations and worming/fecal examinations?
- None -
Yes
No
Due on
Does your pet need any of the following?
Fecal
Heartworm Test
Nail Trim
Microchip ($27)
Vaccines
Other
Other
Does your pet need any medications refilled?
Yes
No
Refilled
Flea
Tick
Heartworm
Ear
Thyroid
History
Lifestyle
Indoor
Outdoor
Companion Dog
Performance Dog
Breeding Dog
Service Dog
Describe his or her housing and lifestyle
Does your pet travel?
In state
Out of state
Board
Dog events
Locations
Name of your previous veterinary clinic
Phone
Fax
Are there tests or x-rays from a previous illness or injury?
- None -
Yes
No
If yes
If you are new to us, may we request records from your previous veterinarian?
- None -
Yes
No
Reason you are not at your previous veterinary clinic today?
Emergency care not available
Dissatisfied with service
Dissatisfied with medical care
Did not have available appointment
Services offered here they do not offer there
Other
Other
Symptoms
Do you have any concerns about your pet’s health?
- None -
Yes
No
If Yes, Please Review Below
When was your pet last normal?
What symptoms have you noticed?
What symptoms did you notice first? How long ago?
Are the symptoms getting better/ worse/ staying the same?
Has your pet been treated for this condition in the past? Describe medications and responses
Is your pet acting normally?
- None -
Yes
No
If no, please describe
Do you have pet health insurance?
- None -
Yes
No
Name of provider?
Preferred Method of Payment:
Methods
- None -
Cash
Check
MasterCard
Visa
Discover
Care Credit
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
