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Chiropractic Care – Initial Appointment Questionnaire:
To be used with repeat Chiropractic appointments
Chiropractic Care – Initial Appointment Questionnaire:
Your Name
*
First
Last
Pet's Name
*
First
Email
*
Enter Email
Confirm Email
Phone - Best Contact #
1. Tell us a bit about why you are seeking chiropractic care for your pet:
2. How long has this problem been going on?
3. Is your pet limping or experiencing lameness, stiffness, or mobility issues?
Yes
No
If yes, please explain
4. Have x-rays or other diagnostics been performed regarding the specific concern you wish to address at your pet’s upcoming appointment?
Yes
No
If yes, please explain which diagnostics, where and when.
5. In the last 48 hours has your pet:
• 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
6. Is your pet itching or scratching?
Yes
No
If yes, please explain
7. Does your dog have any long-term medical conditions that we are unaware of?
Yes
No
If yes, please explain
8. List all current medications and supplements your pet is taking - please include the dose and/or serving size, frequency, and the supplement brand (where applicable).
9. Tell us about your pet’s exercise routine:
10. Tell us a bit about your home environment:
11. Any recent household or lifestyle changes you wish to discuss at your appointment?
Yes
No
If yes, please explain
12. Is there any other important information about your pet 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.
Home
New Clients
What to Expect
New Client Application Form
About Us
Meet Our Team
Career Opportunities
Services
Traditional Chinese Medicine
Acupuncture
Homotoxicology
Chiropractic Services & Laser Therapy
Wellness, Vaccination & Titer Testing
Surgical & Dental Services
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
Parasite Prevention Library 2024
Titer Testing Partner Program
Client Portal
Contact
Emergencies