Horizon Veterinary Services
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FAX: 502-722-8231 Consultation Questionnaire Form What is your name, phone number & address? _________________________________________________________________________________________________ What is your pets name, age, breed, sex, and description? ________________________________________________________________________________________________ What is the current problem or problems? ________________________________________________________________________________________________ How long has your friend had the problem(s). ________________________________________________________________________________________________ What medications or treatments has your friend received and have they helped the problem? _________________________________________________________________________________________________ _________________________________________________________________________________________________ What diet is your pet on? What treats does he/she receive? _________________________________________________________________________________________________ _________________________________________________________________________________________________ What heartworm or flea treatments has your pet received? _________________________________________________________________________________________________ What is your pets vaccination history? _________________________________________________________________________________________________ _________________________________________________________________________________________________ Has there been any change in eating or drinking habits?
_________________________________________________________________________________________________ It would be helpful to send any lab work. More questions may need to be
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