Skip to content
Toggle Navigation
Request Appointment
Visit Our Other Mt. Pleasant Locations
(843) 884-4494
Menu
Home
About Us
Meet Our Team
Philosophy
Story
Services
Wellness & Prevention
Dental Care
Surgery & Pain Management
Diagnostics
Physical Rehabilitation
Acupuncture
End of Life Care
Penn-HIP
Client Corner
Forms
New Client Form
New Family Members
Acupuncture and Physical Rehabilitation Questionnaire
Helpful Links
Information Packets
Video Library
Diagnosis
Online Store
Blog
Careers
Contact
"
*
" indicates required fields
Step
1
of
3
33%
Acupuncture & Physical Rehab Questionnaire For Shuler Vet Clinic SC
Client Name
*
Pet Name
*
Phone
*
Email
*
Has your pet ever had acupuncture?
Yes
No
If so, date of last session and outcome.*
*
Primary concern(s):
*
What is your pet's primary concern/problem areas?
How long has this been a concern?*
List all medications and supplements your pet is on*
*
If not applicable please put None.
List all foods/treats your pet eats
Describe your pet’s appetite, time of day he/she eats.*
Is your pet a picky eater
Have you noticed increased thirst?
Yes
No
What are your pets drinking habits?*
*
drinks a lot at once
drinks small amounts many times throughout the day
Temperature preference
*
Shade or cool locations (tile, in front of AC vents)
Sun or warm locations (carpet, bedding)
Sleeping habits:
*
sleeps through the night
gets up and moves around through the night
has a hard time falling asleep
dreams frequently
Other
Other sleeping habits to note:*
*
Stool Quality
*
normal
dry/hard
bloody
malodorous
soft/loose
diarrhea
Urination Quality
*
normal
short, frequent streams
bloody/malodorous
urinary leakage
long streams
diarrhea
Is your pet sneezing or coughing?*
*
Yes
No
If coughing or sneezing, please describe:*
*
Has there been any vomiting?*
*
Yes
No
Have there been any changes to your pet’s energy and/or stamina?
*
Yes
No
Describe your pet’s typical daily exercise/activity routine
Has there been a change in this routine? Explain
What is your pet’s personality?
*
bossy/aggressive
very friendly - runs up to play with other dogs/people
happy to play, but lets them come to him/her
doesn’t really care/aloof
timid/scared/runs away
Is your pet patient?
*
Is your pet easily excited/startled? (Doorbell, loud noises)
*
Does your pet seem to like rules or “need a job”?
*
(For Dogs) How does your pet interact with other dogs?
How does your pet interact with other people?
Has your pet had any major illnesses, injuries, or surgeries in his/her lifetime?
Is there anything else I should know about your pet?
Has your pet ever had acupuncture?
Page load link
Go to Top
