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Acupuncture – Follow-Up Appointment 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.
Acupuncture – Follow-Up Appointment Questionnaire:
Your Name
*
First
Last
Pet's Name
*
First
Email
*
Enter Email
Confirm Email
Phone - Best Contact #
1. Since your pet’s last visit, overall, how have they been doing?
2. What type of response did you notice with your pet immediately following the acupuncture treatment? Please describe:
3. Did you notice improvements, changes or decline in your pet’s condition within the first few days of the last treatment? Please explain:
4. Are there any new concerns with your pet since the last acupuncture treatment?
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 taking any new medications & supplements since their last treatment?
7. Any recent household or lifestyle changes since their last treatment?
Yes
No
If yes, please explain
8. 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.
Name
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
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
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