Shares Reason for Visit:* Foster Animal Name(s)* Current Weight(s)* Volunteer Name* First Last Today's Date* MM slash DD slash YYYY Any concerns about the animals’ appetite?* Yes No What is the animal eating?* How often?* How much?* Is their appetite consistent or are they picky?* Have you tried any other diets?* Yes No If yes, what types of food have you tried?* How long has this problem been going on for?* Are there any additional appetite concerns? Any concerns about the animals’ stool?* Yes No What grade is the stool?*Please enter a number from 1 to 7.Any blood in the stool?* Yes No How often are they defecating?* Did the animal get into anything they shouldn’t have?* Yes No If yes, what did they get into?* Were they offered a different diet or treat?* Yes No If yes, what were they given?* Have you seen any evidence of parasites? (roundworm or tapeworm segments)* Yes No Are the cats over 3 weeks old using the litterbox?* Yes No How often is this happening?* Is litterbox usage consistent or intermittent?* How is house training the puppy or dog going?* Are there any additional concerns? Any concerns about the animals’ urination?* Yes No How often is the animal urinating?* Are they urinating small amounts?* Yes No Any blood present?* Yes No Are the cats over 3 wks using the litterbox?* Yes No Are the cats going in and out of the box?* Yes No Straining?* Yes No How long has this problem been going on?* Are there any additional concerns? Any concerns about URI/Kennel Cough?* Yes No Sneezing?* Yes No Coughing?* Yes No Nasal Discharge?* Yes No How long has this problem been going on for?* Is it consistent or intermittent?* Is it worsening?* Yes No Any lethargy?* Yes No Has their appetite has been affected?* Yes No Are there any additional concerns? Any ocular concerns?* Yes No Redness?* Yes No Squinting?* Yes No Discharge?* Yes No How long has this been going on?* Is it consistent or intermittent?* Are there any additional concerns? Any auricular concerns?* Yes No Any head shaking?* Yes No Pawing at ears?* Yes No Redness?* Yes No Swelling?* Yes No Any dark debris or other discharge in the ears?* Yes No Are there any additional concerns? Any skin concerns?* Yes No Redness?* Yes No Hair loss?* Yes No Signs of Parasites?* Yes No Lumps or Bumps?* Yes No Is the animal itchy or painful?* Yes No If yes, please describe:* Are there any additional concerns? Can you think of any other issues that we have not covered?* Yes No If yes, please describe:*Next Appointment: Staff Initials:* Shares
