Respiratory Issues Form Name * First Name Last Name Pet's Name * Any coughing or sneezing? * Yes No If yes, how often in a day? Any nasal discharge? * Yes No Any Labored breathing? * Yes No Any difficulties breathing while at rest? * Yes No Any difficulties breathing during exercise/excitement? * Yes No Does your pet wear a harness or neck lead? * Any exposure to other pets at dog parks/groomers/playdates? * Yes No Any history of allergies? * Yes No Current Diet? * Any GI Upset? * Yes No Please list all current medications, supplements, or herbals: (if no change from last visit, just write N/C) * Your form has been successfully submitted. Thank you!
