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1st Puppy Vaccine/Titer/Wellness Exam Questionnaire:
Thank you for taking the time to complete this form prior to your scheduled appointment. It allows us to prepare for your appointment ahead of time and helps to keep things running smoothly. All of the required fields must be completed in order to successfully submit this form. If one or more area is missed, you will be unable to submit and the missing answer(s) will be highlighted in red. You will need to complete the missing answer(s) and re-check the captcha box at the bottom to submit. A copy of this form will be sent to you at the email address entered below, after you have completed the form submission.
1st Puppy Vaccine/Titer/Wellness Exam Questionnaire
Your Name
*
First
Last
Pet's Name
*
First
Email
*
Enter Email
Confirm Email
Phone - Best Contact #
Keeping up with the times:
During your appointment today we would like the option to use veterinary AI scribe software to assist in our record keeping processes. This tool will allow the veterinarian to focus more on your pet's care by reducing the time spent on computer-related tasks. It captures and converts the conversation into text, which is then summarized into a clinical note. The veterinarian will review and edit this note before adding it to your pet's file.
May we have your permission to use the veterinary scribe software during this appointment and in any future consultations at this practice?
*
Yes
No
Did you receive the "Congratulations on your New Puppy" email from Main Street at the time your appointment was booked?
*
This email includes a link to some helpful articles and to our New Puppy Essentials video, covering the fundamentals of puppy care. You'll find information on socialization, bite inhibition, vaccinations, veterinary care, and more.
Yes
No
Have you taken the time to review the New Puppy Essentials video and explore the links?
*
Yes
No
1. In the last 48 hours has your puppy:
• Been coughing or sneezing?
Yes
No
If yes, please explain
• Vomited or had diarrhea?
Yes
No
If yes, please explain
• Been eating and drinking normally?
Yes
No
If no, please explain
2. What is your puppy’s current diet, brand of food, number of times fed daily, and amount of each feeding? If home prepared, please provide recipe(s):
3. Are you looking to learn more about alternatives to traditional kibble feeding for your puppy?
Yes
No
4. Please provide a current list of your puppy’s medications & supplements including dosage and frequency:
5. Is your puppy itching or scratching?
Yes
No
If yes, please explain
6. Is your puppy limping or experiencing lameness, stiffness, or mobility issues?
Yes
No
If yes, please explain
7. Are you a first-time dog owner?
Yes
No
8. Is this your puppy’s first visit to the vet?
Yes
No
If no, please provide details of any vaccination or deworming including type and date given (if possible)
9. Do you know if your puppy has had any previous vaccine reactions?
Yes
No
If yes, please explain
10. Do you know what titer testing is?
Yes
No
11. Does your puppy:
• Travel outside of the home area?
Yes
No
If yes, please explain
• Have contact with other dogs (e.g. Dog park, boarding, shows)
Yes
No
If yes, please explain
12. Do you plan to perform annual Heartworm testing with this pet?
Yes
No
Unsure
13. Do you plan to give monthly heartworm preventive medications?
Yes
No
Unsure
14. Do you require more information about heartworm testing and heartworm preventive medications?
Yes
No
15. Tell us about your puppy’s exercise routine:
16. Tell us a bit about your home environment:
17. Any recent household or lifestyle changes you wish to discuss at your appointment?
Yes
No
If yes, please explain
18. Does your puppy have any long-term medical conditions that we are unaware of?
Yes
No
If yes, please explain
19. Do you have a specific concern you wish to address at your puppy’s upcoming appointment?
Yes
No
If yes, please explain
20. Is there any other important information about your puppy that we should be aware about prior to their upcoming appointment? If you have multiple issues to discuss, please be aware there may not be time to discuss all of them at this appointment and your vet may select the most important to your pet’s health. Another appointment may be required to address additional concerns.
Phone
This field is for validation purposes and should be left unchanged.
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Home
New Clients
What to Expect
New Client Application Form
About Us
Meet Our Team
Career Opportunities
Clinic Policies
Services
Traditional Chinese Medicine
Acupuncture
Homotoxicology
Chiropractic Services & Laser Therapy
Wellness, Vaccination & Titer Testing
Surgical & Dental Services
Refill Request
Pet Health
Holistic Articles
Educational Articles
Pet Health Checker
Helpful Links
News
Resources
Our Videos
Introduction Video
Traditional Chinese Herbal Medicine Video
Acupuncture Video
Chiropractic Video
Travelling to the U.S.
Parasite Prevention Library 2025
Titer Testing Partner Program
Client Portal
Contact
Emergencies
facebook
instagram
