952-929-5800
7701 Cahill Road
Edina, MN  55439

Before Your Appointment

If you have an appointment scheduled with us, you may fill out a Patient Assessment Form in advance.  This will ensure that we have accurate and up to date health information for your pet.  Filling out the form in advance will also allow our staff to spend more time discussing any concerns that you may have at the time of your appointment.

You may fill out the Patient Assessment form online and email it back to us anytime before your appointment.

Form - Patient Assessment Form

Name (required)
First Name (required)
Last Name (required)
E-Mail Address :
Pet Information
Pet's Name (If you are bringing more than one pet, please fill out an additional assessment form.) (required)

Vaccination History
Is your pet current on vaccinations? (CANINE) (check all that apply)
Distemper
Rabies
Bordetella
Lyme
Porphymonas
Lepto
Is your pet current on vaccinations? (FELINE) (check all that apply)
FRCP
Rabies
Calici
Feline Leukemia
Has your pet ever had a reaction to vaccines?
Yes
No
If your pet has had a reaction to vaccines, briefly describe what happened.

Heartworm, Flea, and Tick Prevention
Is your pet on heartworm preventative?
Yes
No
If you answered yes above, do you give heartworm preventative
Seasonally
All year
If your pet is on heartworm preventative, what kind are you using?
Heartgard
Sentinel
Interceptor
Revolution
Other
Is your pet on flea and tick prevention?
Yes
No
If yes, what kind of flea and tick preventative are you using?
Frontline Plus
Promeris
Will you need a refill on your heartworm or flea and tick preventative?
Yes
No
Medications
Is your pet on any medications, vitamins, or supplements?

Please list below any medications that you need refilled.

General Health
Eyes (check all that apply)
Normal
Discharge
Irritated
Ears (check all that apply)
Normal
Sore, Inflamed
Smell
Nose (check all that apply)
Normal
Discharge
Sneezing
Mouth (check all that apply)
Normal
Drooling
Trouble Chewing
Smell
Do you brush your pet's teeth?
Yes
No
Throat (check all that apply)
Normal
Gagging
Swollen
Respiratory System (check all that apply)
Normal
Wheezing
Labored Breathing
Coughing
Haircoat (check all that apply)
Normal
Dry
Oily
Excess Shedding or Hair Loss
Skin (check all that apply)
Normal
Growths
Lesions or Sores
Joints (check all that apply)
Normal
Lame
Difficulty Getting Up
Swollen
Tender
Legs (check all that apply)
Normal
Weak
Muscle Loss
Urogenital-Vagina/Penile area (check all that apply)
Normal
Discharge
Red
Swollen
Smell
Circulatory System (check all that apply)
Normal
Lethargic
Listless
Weak
Fainting
Lack of Edurance
Behavior/Nervous System (check all that apply)
Normal
Change in Behavior
Seizures
Shaking
Twitching
Housetraining (check all that apply)
Normal
Abnormal urinating in the house
Abnormal stooling in the house
Gastrointestinal (check all that apply)
Normal
Vomiting
Diarrhea
Change in Eating
Change in Drinking
Nutrition
What kind of food do you feed your pet?

What is the quantity of food you give each feeding?

How many times a day do you feed?
Once
Twice
Three Times Daily
More
Treats?
Yes
No
If your pet receives treats what kind do you feed and how many per day?

Does your pet receive any of the following? (check all that apply)
Rawhides
Greenies
Table Food
Other
Lifestyle
About how much time does your pet spend outside?
100%
75%
50%
25%
0%
Only to urinate or defecate
When your pet goes outside are they (check all that apply)
In a fenced backyard
On a leash
Contained in the yard with Invisible Fencing
Free Roaming
Does your pet (check all that apply)
Go up north
South
Visit dog parks
Visit pet stores
Board at a kennel
Go to a training facility
Hunt
Have access to lakes/ponds
Have access to heavily wooded areas
Please list any additional comments or concerns that you would like to address at your appointment.


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