Comprehensive History Questionnaire 2024

"*" indicates required fields

The Appointment Details

Day of Week Preference*
This appointment type is scheduled each Monday and Friday only
Appointment Time Preference*
How may we reach you to confirm details?*

About You and Your Pet

So that Dr. Kangas may best prepare for your comprehensive consultation, please complete and submit the information below. Notes: All questions require a response, if the answer is no or none, please simply type NONE or N/A in the prompt. Average time to complete is 10 minutes. Please be sure to have a photo of your pet available to upload.
Your Name*
Address*
Species*
Sex*

Presenting Concern

History

Medical

ie. or any references we need to obtain medical records which you consider pertinent for Dr. Kangas to review your pet's medical history. *International clients, please also provide an email address of any attending veterinarians.
if yes, which product(s)
if yes, which product(s)

Diet & Environment

Behavior & Exercise

Max. file size: 256 MB.
ensure a clear face view

Other

i.e. Google search, pet health podcast or live event, referral from friend or family member, referral from veterinarian. other.
Please select your preferred method of communication for appointment reminders*
We like to share our patients on social media. Do you consent to allow us to post images of your pet to our social media, including but not limited to Facebook, Instagram and our website?*

PLEASE READ AND SIGN BELOW:

By submitting this form, I authorize Integrative Veterinary Care practitioners to treat my pet.
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