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whitehillsah@gmail.com
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Home
About
- Our Story
- Our Team
- Photo Gallery
- FAQs
Services
Resources
MyVetStore
Contact
Appointment

Canine Annual Form

Save time during your next canine annual appointment. Complete your required form online from any device at any time before your visit.

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Canine Annual Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

What is your FIRST and LAST NAME? *

First

Last

What is your PET'S NAME? *

What is your phone number? *

Has your dog ever had a bad reaction to their vaccines? *

Does your dog have a cough? If coughing, When did it start? When does it occur? Is it getting worse or resolving? *

Is your dog sneezing? If sneezing, when did it start? When does it occur? Is it getting worse or resolving? Is there a discharge? If so, what color: *

Is your pet vomiting? If vomiting, when did it start? When does it occur (how soon after eating)? Is it getting worse or resolving? Is there blood in the vomitus? What is vomited? Any history of dietary indiscretion? *

Has your pet had diarrhea? If no, please answer no to the following questions.

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When did it start?

Is there blood or mucous in the feces?

When does it occur?

What is the fecal consistency?

Is it getting worse or resolving?

Any history of dietary indiscretion?

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Any history of tremors/seizures? *

Yes
No

Please Specify

Any new or changed lumps/bumps/skin lesion? *

Yes
No

Please Specify

Any changes in urination? *

Yes
No

Please Specify

Any history of scratching/hair loss? *

Yes
No

Please Specify

Any changes in thirst? *

Yes
No

Please Specify

Has the elimination (BM and urination) habits changed since last visit? *

Yes
No

Please Specify

How much water consumed daily?

Food

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Does your dog have a good appetite?

How often and how much is fed?

Can they have treats while they are here in the clinic?

What food is fed?

Are any table scraps fed?

When will your dog have last eaten before its appointment? *

What supplements are given, and when was last dose given?

What medications are given, and when was last dose given?

Any over the counter flea products (spot-on, shampoos, foams, sprays) given, and when was last dose given?

Any changes in...

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Vision?

Hearing?

Temperament?

Have you noticed any changes in your pet's personality since the last visit?

Yes
No

Please Specify

Do you consider these behaviours a problem?

Yes
No

Please Specify

Any changes in mobility (gait changes/stiffness/sore to touch)? *

Yes
No

Please Specify

Have you noticed any changes in the way that your pet greets or interacts with other pets or people? Has there ever been a concern with biting or nipping at other pets or people?

Any new fears or phobias since last visit?

Yes
No

Please Specify

Does your pet currently have any behaviour problems that you are concerned about?

Yes
No

Please Specify

Lifestyle

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History of boarding?

Plans to travel outside London?

Would you like the Bordetella (Kennel Cough) vaccine today?

Plans to board?

Has your pet been to the leash free park?

History of travel outside London?

Will your pet go to the leash free park in the future?

We recommend that core vaccinations (Rabies, and Distemper/Parvovirus vaccines) are kept up to date to ensure the protection of your pet against serious and life-threatening diseases. WOULD YOU LIKE TO UPDATE CORE VACCINES TODAY (IF DUE)?

Yes
No
I would like more information

Leptospirosis is a serious bacterial disease that is transmitted by common wildlife and is present within the city of London. Infection with this bacteria, through contaminated soil or water sources, can cause kidney and liver disease in dogs. Moreover, it can be transmitted to people as well. WOULD YOU LIKE THE LEPTOSPIROSIS VACCINE TODAY?

Yes
No
I would like more information

Lyme disease is caused by a bite from an infected deer tick. The Lyme vaccine is recommended for dogs traveling to high risk areas for ticks (anywhere along the coast of Lake Ontario or Erie) to provide additional protection against this disease. WOULD YOU LIKE THE LYME VACCINE TODAY?

Yes
No
I would like more information

Any other pets at home that do not come to Whitehills?

Yes
No

Please Specify

Other observations of concern?

Are there any specific areas on your pets body that they are very nervous of having touched/ don't like having handled?

We recommend Interceptor Plus for heartworm prevention, and Credelio for flea/tick prevention, unless your pet requires a topical medication.

If Heartworm prevention is elected, we do require an up to date 4DX test.

Yes my pet needs heartworm prevention dispensed today
Yes my pet needs flea/tick prevention dispensed today
No my pet does not need heartworm prevention dispensed today
No my pet does not need flea/tick prevention dispensed today
My pet receives a topical medication

How many doses of prevention would you like today? We recommend 12 months *

Do you consent to a blood test for heartworm and tick borne diseases if recommended? The cost is $64 + HST. We recommend this test annually to check for tick borne diseases. If Heartworm prevention is elected, we do require an up to date 4DX test.

Yes
No

Questions for COVID19 screening:

Have you, or someone you live with, been sick with symptoms associated with Covid19 in the last 5 days?

Name

Make an Appointment

You can schedule an appointment by clicking the button below.

QUESTIONS?

We look forward to hearing from you!

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Address:

2111 Aldersbrook Rd.
London, ON N6G 3X1

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Contact Information

Phone: (519) 473-1182
E-mail: whitehillsah@gmail.com

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Email *

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How can we help you? *

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Hours

Mon & Wed: 8:00am – 7:30pm
Tues, Thurs & Fri: 8:00am – 6:00pm
Sat: 8:00am – 12:00pm
Sun: Closed

Our phone lines are off for lunch daily from 12:30 pm – 1:30 pm.
The phones are turned off 1 hour prior to close.
On Saturdays, our phones are turned off at 10:00am.

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