Page 637 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice
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624 SPECIAL THERAPY
Date: Reason for today’s visit:
Weight (lb): Body condition score (1-5)
Current Usual
History taken by:
I. Pet Information
Pet name: Species:
Breed: Age: Sex:
Spayed or neutered?
Pet’s activity level (type, duration, frequency):
Current or past diseases or problems:
Current medications:
Most recent thyroid level check:
How is pet’s appetite?
Estimated energy needs (see chart):
II. Diet Information
The following descriptions should be sufficently specific that a member of the practice could go to a store and purchase the food
described.
How Much Is Fed? How Often Is the Food Fes?
Food Fed (Brand Name; (What is the Size of the (Is It Fed on a Free-Choice Basis?
Dry or Canned?) Cup or Can Used?) How Many Meals per Day?) Calories per Day
Usual
Recent (since when?)
Total calories per day:
What Type of Treats or
Table Food Is
Fed Each Day? What Is
Brand Name of
Treat or Special Food? How much? How Often? Calories per Day
Pet treats: Size S, M, L, XL
Figure 26-1 (Continued)
