Click here to login to NorthStar VETS Referring Doctor portal.     Make a Payment Online     American Animal Hospital Association
315 Robbinsville-Allentown Rd., Robbinsville, NJ 08691
2834 Route 73N, Maple Shade, NJ 08052
507 Route 70, Brick, NJ 08723

Cardiology Recheck Questionnaire

Pet's Name:*

Owner's Name:*

Owner's Email:*

NorthStar VETS Location:
Robbinsville     Maple Shade

How are your pet's symptoms: (Elaborate and include duration as needed.)

Normal     Decreased     Increased

Please Explain

Normal     Decreased     Increased

Please Explain

Normal     Decreased     Increased

Please Explain

(If abnormal, please describe color and consistency. Any blood, mucus, straining, increased frequency or increased urgency to defecate)

Normal     Decreased

If abnormal, please describe color, any blood, and straining, leaking,accidents in the house, increased frequency or urgency to urinate

Yes     No

If yes, please describe what the vomit looks like and how often your pet is vomiting

Coughing/Hacking Cough?
Yes     No

If yes, please describe how often, if coughing is worse at any certain time of the day and if the cough is worsened by exercise or excitement

Yes     No

If yes, please describe how frequently this has occurred, how long the episodes last, what happened right before the episode and how long does it take for your pet to return to "normal"

Labored Breathing?
Yes     No

(If yes, please describe when this occurred, was any medication given or prescribed to help improve the breathing?

Activity Level
Normal     Decreased     Increased

Please describe when you first noticed a change in your pet's activity level


What current medications is your pet taking? Please list all name, dose and frequency if known. (please list dose in milligrams if known):

Does your pet need any refills on any of his/her medications?
Yes     No

If yes, please note which medications

Would you like medications filled here or written prescriptions to fill at your local pharmacy?
NorthStar Vets     Pharmacy