Owner's Name:
E-Mail Address:
Phone Number:
Pet's Name:
Your pet is acting normal, active, and in good spirits.
YES
NO
Appetite is normal and has no difficulty in chewing or
swallowing.
YES
NO
Breathes normally, without straining
YES
NO
Urinates in the usual amounts and frequency.
YES
NO
He / She has normal appearing bowel movements.
YES
NO
Your pet walks without stiffness, pain, or difficulty.
YES
NO
Coat is full, glossy, and in good condition.
YES
NO
Skin is free from dry flakes, and not greasy.
YES
NO
He / She has no fleas, ticks, lice, or mites.
YES
NO
Teeth are white, and free of tartar.
YES
NO
Gums are clean, and pink, with no redness.
YES
NO
Ears are clean, without debris inside.
YES
NO
Nose is moist and free of discharge.
YES
NO
Eyes are glistening are bright, clear, and free of matter.
YES
NO