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Hours & Contact
Monday through Friday: 8:30am - 6:00pm
Sat : 8:30am - 1:00pm
Call: (618) 344-2097
Fax: 618-344-2142
[email protected]
An AAHA Accredited Clinic
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Pet Health History Form
Owner's Name
Email address
Owner's Phone Number
Pet's Name
Reason for Visit
When did the problem start, describe progression
Illness: Please indicate past illnesses or conditions
Select any current symptoms
Coughing
Sneezing
Vomitting
Diarrhea
Not eating
Weight Loss
Weight Gain
Excessive Drinking
Excessive Urination
Lethargy
Eye Discharge
Behavior Change
Other…
Enter other…
Is your pet on Heartworm prevention?
Yes
No
What type?
Is your pet on Flea/Tick prevention?
Yes
No
What type?
What is your pet’s current diet?
Amount/frequency?
Do you give your pet any supplements?
Has your pet ever had an adverse reaction to any medications or vaccines
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