Behavior Recheck Questionnaire

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Please fill out this questionnaire as completely as possible. If you have any questions or need clarification on any of the choices, please contact us. As always, thank you for entrusting us with your pet’s care!

Please list your pet’s current issues and indicate whether they are pre-existing or new since your last visit. For pre-existing issues, please note what changes there have been. Pre-existing issues-for each problem, rank the change in intensity and frequency according to the following scale:

Intensity:

  1. Worse
  2. <25% improvement
  3. 25-50% improvement
  4. 50-75% improvement
  5. >75% improvement

Frequency

  1. Worse
  2. <25% improvement
  3. 25-50% improvement
  4. 50-75% improvement
  5. >75% improvement

Have any of the following changes occurred since our last visit?






Check all that apply

This field is for validation purposes and should be left unchanged.







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  • 1

    Call us or schedule an appointment online.

  • 2

    Meet with a doctor for an initial exam.

  • 3

    Put a plan together for your pet.

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