Vet-to-Vet Medication Consultation Form - Metropolitan Veterinary Associates

Name

This field is for validation purposes and should be left unchanged.

General Information & Medical History

Clinic name*

Veterinarian’s name*

If specialist, please note specialty*

If other, please describe

How did you hear about us?

Date of last blood work*

Any abnormal results*

If yes, list name, dates, dose, effect, and why it was discontinued*

Chronic medical conditions details*

Pain details*

Appetite details

Basic Pet Information

Pet’s name*

Signalment*

Include species, breed, sex, age, and any other relevant details.

Weight (kilograms)*

Does the pet have signs of generalized anxiety disorder?

For example: easily startled by subtle noises, difficulty settling in the home, etc.

Current Behavior Problems

Describe the main behavioral concerns for the pet that prompted the consultation*

Veterinary Visit Anxiety

What has been attempted?

For example medications/supplements/pheromones not already listed above, specific entrance protocol, specific room setup, adjusted staff interactions, training protocols/working with a specific trainer, sedation.

Have any previous interventions been effective? Which ones?

Any notable factors that increase the patient’s stress?

For example, pet parent’s absence, seeing other patients in the lobby, specific staff members, etc.

Future Considerations

What are the client’s goals for treatment?*

Additional comments

Please leave any comments about the form or information that did not fit in any other section.