GVH Pre-Wellness Exam Questionnaire (Dogs)

Please fill out a questionnaire for each pet coming in for an annual wellness visit.

General Information

Primary Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If this is a cell number, we can send you text reminders for appointments.

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This is where you'd like to receive health service reminders and detailed appointment reminders, in addition to the text reminders. You can opt out of one or the other at any time.

 

 

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If your pet received a rabies vaccine or any other vaccines from another veterinarian, please provide us with their contact information and we'll gladly call to obtain those records for you. Please be aware that if the rabies vaccine is expired, records cannot be obtained by us or you aren't able to bring them in, we will be required by law to administer this vaccine at the time of the visit.

PLEASE READ CAREFULLY:

If your pet's previous vaccine or medical records are at one of these 3 places, we will need your help obtaining the information.

  • Banfield Pet Hospital - they will not release records to us unless you call and give your permission. The fastest way to get us your pet's records is for you to call and ask them to email the records to us at recep@gtvet.com.
  • Emancipet - you will need to sign a release form on their website before we can obtain records.
  • Dr. Tarleton at Austin Ave. Animal Hospital - Dr. Tarelton keeps paper records and does not have access to email or a fax machine. You will need to bring your records in for us to copy.

 

 

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Please list all medications and suppliments your pet takes on a regular basis, how much and how often.

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Please tell us the name of the food, how much you feed them and how often.

Will you need us to fill out a pet insurance claim form or provide you with records from your visit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you do not yet have pet insurance but would like more information, please go to our website! We give you the names of a few companies some of the staff and our clients use. You'll also find links with coverage questions and a comparison chart to help you make the best decision for your family. Please let us know if you have any questions!

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Annual Wellness Options

Please read through each of the items listed below and indicate what you'd like to have done for your pet. A yearly wellness visit for a dog typically consists of the following:

Please read through each of the items listed below and indicate what you'd like to have done for your pet. A yearly wellness visit for a dog typically consists of the following:

Physical Wellness Exam {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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All pets will receive a comprehensive exam by the doctor to ensure they are in good health. This will enable the doctor to continue approving prescriptions for your pet for the next year.

Yearly Intestinal Parasite Screen {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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We support the recommendations of the American Veterinary Medical Association and the Center for Disease Control and recommend at least once a year intestinal parasite screens for all dogs. Whether they spend their time mostly indoors, or outdoors, dogs can contract and spread intestinal parasites many different ways, including hunting and exposure to areas where other animals have been.

Yearly Heartworm Test {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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The FDA and our doctors believe it is vital to your dog's health to ensure the heartworm prevention you're using is protecting your pet. There have been some strains of drug resistant heartworms found in the US.

Rabies Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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The state of Texas requires this vaccine for all dogs. The frequency of administration is based on age and previous vaccine history. Rabies is a fatal virus that attacks the central nervous system and is contagious to humans.

DAPP Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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This is a combination vaccine containing Distemper, Adenovirus, Parainfluenza and Parvovirus. This vaccine is considered a core vaccine for all puppies and is then given according to age and previous vaccine history.

Leptospirosis Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Leptospirosis is a disease that is contagious to humans and transmitted through the urine of wildlife (raccoons, foxes, squirrels...) Georgetown is a fabulous community full of wildlife, so our doctors consider this vaccine important for all dogs.

Bordetella Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bordetella is a bacteria that causes respiratory infections. This vaccine is important for dogs that go to grooming, boarding, training and dog parks.

Canine Influenza Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Influenza is the virus that causes the flu. The vaccine we use is designed to protect against the strains found in Central Texas. It is important for dogs who to grooming, boarding, training and dog parks.

Rattlesnake Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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This vaccine helps to reduce the life-threatening effects of all crotalis species snakes (rattlesnakes, copperheads). You would still need to seek immediate veterinary care for your pet if they were bit, but it will buy you time to get them to a facility with anti-venom. We only recommend this vaccine for pets who have a high likelihood of encountering a rattlesnake.

Has your pet ever had an adverse reaction to a vaccine? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will you need to purchase heartworm prevention for your pet? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will you need to purchaseflea/tick/parasite prevention? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Young Wellness Panel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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This is a baseline blood panel, intestinal parasite screen and heartworm test recommended for all dogs under 6 years of age. It checks to see if all organ systems are healthy and serves as a valuable reference as your pet ages.

Senior Wellness Panel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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This is a comprehensive blood panel recommended yearly for all dogs over 6 years of age. Having bloodwork done for geriatric pets is crucial for longevity, early detection of disease and management of conditions.

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GVH Pre-Wellness Exam Questionnaire (Dogs)

GVH Pre-Wellness Exam Questionnaire (Dogs)

Please fill out a questionnaire for each pet coming in for an annual wellness visit.

General Information

Primary Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Appointment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Primary Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Previous vaccine and medical records {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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PLEASE READ CAREFULLY:

If your pet's previous vaccine or medical records are at one of these 3 places, we will need your help obtaining the information.

  • Banfield Pet Hospital - they will not release records to us unless you call and give your permission. The fastest way to get us your pet's records is for you to call and ask them to email the records to us at recep@gtvet.com.
  • Emancipet - you will need to sign a release form on their website before we can obtain records.
  • Dr. Tarleton at Austin Ave. Animal Hospital - Dr. Tarelton keeps paper records and does not have access to email or a fax machine. You will need to bring your records in for us to copy.

 

 

Is your pet currently taking any medication, including heartworm, flea or tick prevention? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What kind of food are you currently feeding your pet? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will you need us to fill out a pet insurance claim form or provide you with records from your visit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you do not yet have pet insurance but would like more information, please go to our website! We give you the names of a few companies some of the staff and our clients use. You'll also find links with coverage questions and a comparison chart to help you make the best decision for your family. Please let us know if you have any questions!

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Annual Wellness Options

Please read through each of the items listed below and indicate what you'd like to have done for your pet. A yearly wellness visit for a dog typically consists of the following:

Physical Wellness Exam {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Yearly Intestinal Parasite Screen {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Yearly Heartworm Test {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Rabies Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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DAPP Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Leptospirosis Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Bordetella Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Canine Influenza Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Rattlesnake Vaccination {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has your pet ever had an adverse reaction to a vaccine? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If "yes," please explain. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will you need to purchase heartworm prevention for your pet? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Will you need to purchaseflea/tick/parasite prevention? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Young Wellness Panel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Senior Wellness Panel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Is there anything else you'd like us to know regarding your visit? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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