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Pet's Name: *
Owner's Name: *
Owner's Email: *
NorthStar VETS Location: Robbinsville Maple Shade
(If abnormal, please describe color and consistency. Any blood, mucus, straining, increased frequency or increased urgency to defecate)
If abnormal, please describe color, any blood, and straining, leaking,accidents in the house, increased frequency or urgency to urinate
If yes, please describe what the vomit looks like and how often your pet is vomiting
Coughing/Hacking Cough? Yes
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
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
(If yes, please describe when this occurred, was any medication given or prescribed to help improve the breathing?
Activity Level Normal
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?
If yes, please note which medications
Would you like medications filled here or written prescriptions to fill at your local pharmacy?
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