The Healing Oasis Veterinary Hospital Comprehensive Information Form

We appreciate your interest in holistic medical care for your pet. AFTER YOU HAVE SCHEDULED YOUR APPOINTMENT BY CALLING THE HEALING OASIS VETERINARY HOSPITAL at 262-886-1100, please take a few minutes to fill out this form as completely and accurately as possible, to help the doctor better assess your pet’s condition.  At the time of your appointment the doctor will perform a physical exam on your pet today and consult with you about your pet’s health concern, history and treatment options.

Your name ____________________ Pet’s name __________________         Date _____

What Veterinarian regularly cares for your pet? _______________________________________________________________

What problem(s) is your pet currently experiencing? _________________________________________________________________________ _______________________________________________________

Has your pet been diagnosed with a medical condition? If so what? _______________________________________________________________

How was the condition diagnosed? (blood work, x-ray, ultrasound etc.) _________________________________________________________________________ _____________________________________________________

What symptoms are you noticing related to this problem(s)? _________________________________________________________________________ ______________________________________________________

What, if anything, has been done for the problem(s)? _________________________________________________________________________ ______________________________________________________

Please list all current medications and supplements with the doses. _________________________________________________________________________ ______________________________________________________

What diet are you currently feeding your pet? _______________________________________________________________

How much are you feeding and how often? _______________________________________________________________

Does your pet get any regular treats, bones or chews? Describe _______________________________________________________________

Is there a certain time of day or year that makes this problem(s) better or worse? _________________________________________________________________________ _______________________________________________________

Do exercises or certain behaviors influence the problem? (running, sleeping, jumping up, etc) _________________________________________________________________________ ______________________________________________________

Have you noticed any vomiting, change in eliminations (urine, stool), change in water consumption or appetite, change in personality? _________________________________________________________________________ ______________________________________________________

Describe your pet’s personality _________________________________________________________________________ _________________________________________________________________________ _____________________________________________

Where did you get your pet? ______________________ How old was he/she at the time? _______________

Did your pet have any medical problems as a puppy or kitten? (ear mites, kennel cough, parasites, etc) _________________________________________________________________________ ______________________________________________________

Has your pet ever had a vaccination reaction? If so describe the reaction _______________________________________________________________

Has your pet ever had a skin problem? Describe it _______________________________________________________________

Does your pet eat strange things? (rocks, sticks, grass, etc) explain _______________________________________________________________

Describe the areas your pet spends the most time, (warm, cool, soft, hard, bright, dark, with people/other animals, alone etc.) _________________________________________________________________________ _____________________________________________________

Does your pet have any unusual behaviors? Explain _______________________________________________________________

If you have other pets in the house please describe them and how this pet interacts with them. _________________________________________________________________________ ______________________________________________________

If you have other people in your household, how does your pet interact with them? _________________________________________________________________________ ______________________________________________________

Have there been any recent changes in the pet’s life/schedule? _________________________________________________________________________ ______________________________________________________

Pleas add any additional information you fill will be beneficial.......

Once completed, please mail to: Healing Oasis Veterinary Hospital; 2555 Wisconsin St; Sturtevant, WI 53177-1825.  DO NOT FAX THE FORM as faxes sometimes smear the hand-written notes.

TO SCHEDULE YOUR APPOINTMENT OR TO CALL with questions please contact us at 262-886-1000 (Monday, Tuesday and Friday 9-12 & 2-6PM; Wednesday 1-7PM

We prefer for originals to be mailed via USPS since sometimes faxes are illegible.

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