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HI Pets Vet Clinic
Bringing Affordable Vet Care To Oahu
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Owner Name:
Owner Email
Owner Phone Number
Owner Mailing Address
Secondary Owner Name:
Secondary Owner Phone Number
Pet's Name
Breed
Color
Sex
Male
Female
Date of Birth / Approximate Age
Does your pet have any known allergies?
Is your animal experiencing any of the following symptoms:
Vomiting?
Diarrhea?
Coughing?
Sneezing?
Discharge (from nose, eyes, and/or genitals)?
Changes in urination or drinking habits?
Changes in energy or activity level?
Changes in mobility (limping, lameness, and/or soreness)?
Changes in behavior?
Changes in appetite?
Any recent food/treat changes?
Changes in weight/body condition?
Itchiness (scratching, licking, head shaking, etc)?
Any new lumps or bumps, or changes in existing ones?
Other Items:
Is your pet indoor only?
Is your pet indoor / outdoor?
Is your pet outdoor only?
Are there other pets in the home?
Is there contact with other pets (dog park, boarding, training)?
Currently taking supplements?
Current on vaccines?
Reason for appointment/presenting problem:
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