Congratulations on your new puppy! Thank you in advance for filling out this questionnaire. It helps to tailor our discussions during your first appointment.

What is your FIRST and LAST NAME? *

First

Last

What is your PET'S NAME? *

What is your phone number? *

Are there any additional people that you would like to add to your pet’s file? This would give them permission to make medical decisions for your pet. *

Yes
No

What is their name(s) and phone number and/or e-mail address?

If you’d like, please let us know how you heard about our clinic

When did you adopt your puppy? Where did you adopt them from?

Have you had a dog previously?

Medical:

How is your puppy doing overall?

Any current or recent coughing? *

Yes
No

When did the coughing start?

What time of day does the coughing occur?

Is the coughing worsening or improving?

Does the coughing worsen with activity?

Is the cough dry or productive?

Any current or recent sneezing? *

Yes
No

When did the sneezing start?

What time of day does the sneezing occur?

Is the sneezing worsening or improving?

Is there discharge from the nose? If so, what colour is the discharge?

Any current or recent vomiting? *

Yes
No

When did the vomiting start?

How often is the vomiting happening? How soon after eating?

Is the vomiting worsening or improving?

Is there blood in the vomit?

What is in the vomit? (ie: food, bile, foam, other)

Any history of dietary indiscretion?

Has there been a food change or different treats given?

Any current or recent diarrhea or soft stools? *

Yes
No

When did the diarrhea start?

How often is diarrhea occurring?

Is the diarrhea worsening or improving?

Is there blood or mucus in the diarrhea?

What is the fecal consistency?

Any history of dietary indiscretion?

Has there been a food change or different treats given?

Any changes in urination amount or frequency? *

Yes
No

Please describe:

Any changes in stool consistency or frequency? *

Yes
No

Please describe:

Any history of tremors, seizures, weakness, or collapse? *

Yes
No

Please describe:

Any new or changed lumps, or new skin lesions? *

Yes
No

Please describe:

Any current or recent scratching or hair loss? *

Yes
No

Please describe:

Any changes in vision or hearing? *

Yes
No

Please describe:

How is your puppy’s energy level?

Any changes in mobility (stiffness, soreness, changes in movement or jumping, or changes in activity level)? *

Yes
No

Please describe:

How are your puppy’s sleeping habits?

Please let us know any ongoing current medical concerns or conditions your puppy has (if they have not been addressed by the previous questions)

Please let us know any past significant medical issues, previous surgeries, or hospitalizations

Has your puppy had any reactions or side effects from previous medications or supplements? *

Yes
No

Describe their previous reaction

Has your puppy ever had an allergic reaction or sensitivity to their vaccines? *

Yes
No

Describe their previous reaction

Has your puppy had any poor reactions during previous anesthesia or surgery? *

Yes
No

Describe their previous reaction

Does your puppy have any other allergies, or are there any serious allergies in the household to be aware of? *

Yes
No

Describe the allergy

Behaviour:

Have you noticed any changes in your puppy's personality or behaviour since adoption? *

Yes
No

Please describe:

Socialization:

Socialization is a critical component of your puppy’s development. It is important that puppies are exposed to new people, other animals, and new experiences in a way that allows them to learn in a comfortable, safe manner.

A great overview on socialization: Importance of Socializing Puppies and Kittens

Has your puppy interacted with people? If so, how have the interactions been? *

Has your puppy interacted with other pets? If so, how have the interactions been? *

Any fears, anxieties, stressors or phobias noticed? * *

Yes
No

Please describe:

Are you concerned about any of your puppy’s behaviour or socialization? *

Yes
No

Please describe:

Training:

House training can begin as soon as your puppy arrives home, and learning where to eliminate is an important skill for them to learn. More tips on house training here: 5 Steps to Successfully Housetrain Your Puppy or Adult Dog

Do you have any questions regarding house-training? *

Yes
No

Please describe:

It is recommended to frequently handle your puppy’s teeth, ears, paws, and other areas of the body from a young age. Aim to focus on this when your puppy is calm, relaxed or sleepy. This can help to make nail trims, teeth brushing or other areas of treatment easier in the future. WOULD YOU LIKE TO DISCUSS BODY HANDLING, NAIL TRIMS, OR TEETH BRUSHING IN MORE DETAIL AT YOUR APPOINTMENT? * *

Yes
No

Please describe:

Puppy classes can be a safe and fun way for puppies to socialize with other people and dogs. There are several great options in London.

Do you plan to sign up for puppy classes? *

Yes - I have already signed up
Yes - I would like more information
No - I am not pursuing puppy classes

Please describe:

Puppies love to chew when they are teething, until all adult teeth are erupted at about 6 months of age. We recommend to avoid any chew toys that can fracture/break teeth (bones, antlers, nylabones) and instead, choose chew toys that soften when compressed (Kongs or similar material). You can also offer frozen wet washcloths to chew, to numb the gums to provide comfort.

Do you want to discuss teething behaviours? *

Yes
No

Please describe:

Has your puppy shown biting, nipping, growling, or lunging at other pets or people? *

Yes
No

Please describe:

Are there any specific areas on your puppy’s body that they are very nervous of having touched, or don't like having handled? *

Yes
No

Please describe:

Our goal is to minimize fear, anxiety and stress during your puppy’s visit to Whitehills. Please try to bring any special treats or toys to the appointment that can help soothe your pet. PLEASE LET US KNOW ANY INFORMATION THAT WOULD HELP MAKE YOUR PUPPY MORE COMFORTABLE DURING THEIR EXAM WITH US.

Nutrition and Lifestyle:

How is your puppy’s appetite? *

What type of food is fed? (include brand of food, dry or canned, homemade, etc) *

How much food is fed each day? *

Is your puppy fed in meals or free choice? *

What treats and table food are fed, and how often? *

Can your puppy have treats or canned food while they are here in the clinic? *

Has your pet had any reactions or sensitivities to specific foods or treats in the past? *

Yes
No

Describe their previous reaction

When did your pet last eat before their appointment? *

Do you want to discuss your puppy’s nutrition at your appointment? *

Yes
No

Please describe:

Is your puppy drinking water well? *

Yes
No

Please describe what you are noticing

How much water is consumed daily? *

Describe your pet’s typical daily activity and exercise (ie length and frequency of walks, backyard time, etc). *

Are you concerned about your puppy’s appetite, thirst, activity or weight? *

Yes
No

Please describe:

Any history of boarding or plans to board in the future?

Any recent or future plans to travel with your pet outside of London? *

Yes
No

What areas will your pet be traveling to?

Does your dog interact with any other dogs (i.e., at leash free parks, grooming, during walks, doggy play dates)? *

Are there any other pets at home that do not come to Whitehills? *

Yes
No

Please describe:

Please list all current medications (include medication name, strength, frequency of administration, and when the most recent dose was given). *

Please list all current supplements (include strength, frequency of administration, and when the most recent dose was given). *

Are any over the counter products (spot-on, shampoos, foams, sprays) used? *

Yes
No

What is the name of the product?

When was it last applied?

Do you have any questions regarding pet insurance? *

Yes
No

Please describe:

Preventative Care

Please note that the preventative care options listed below have an additional charge on top of the annual examination fee. Any additional diagnostics or treatment pursued at the appointment (including nail trims) will also be associated with a fee. Please let us know at your appointment if you would like to review costs prior to proceeding with additional services *

I understand

Microchipping is implanting a small chip (the size of a grain of rice) between the shoulder blades- this identifies your pet to connect them back to you if they become lost. Microchipping is strongly recommended if you will be traveling internationally with your pet (ideally prior to Rabies vaccination). This can be done at any appointment. WOULD YOU LIKE TO HAVE A MICROCHIP PLACED AT THIS APPOINTMENT? *

Vaccines

Vaccination of puppies is very important to maintain their immunity against infectious diseases, as the protection from their mom decreases. More information here: Vaccinations

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 PROCEED WITH CORE VACCINES (IF DUE)? *

Yes
No
I would like more information

The kennel cough vaccine minimizes signs of clinical disease from the most common respiratory infections passed from dog to dog. It is typically recommended for dogs with close contact to other dogs (i.e. at boarding, grooming, dog parks) and for puppies due to their higher risk of illness from kennel cough. WOULD YOU LIKE TO PROCEED WITH THE KENNEL COUGH VACCINE? *

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 severe kidney and liver disease in dogs, and can also be transmitted to people. WOULD YOU LIKE TO PROCEED WITH THE LEPTOSPIROSIS VACCINE? *

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 to provide additional protection against this disease. Current high risk areas for Lyme in Ontario are the majority of the coastline of Lake Ontario and Lake Erie, Grand Bend, Hamilton/Wentworth, and some areas in the Toronto-Montreal corridor. WOULD YOU LIKE TO PROCEED WITH THE LYME VACCINE? *

Yes
No
I would like more information

Parasite Prevention:

Parasites in our pets are grouped into 3 main categories:

Internal parasites: These include intestinal worms and other parasites, which can be passed from the puppy’s mother, or can be picked up in the environment. More info: Gastrointestinal Parasites of Dogs
External parasites: Include fleas and ticks, which can pass additional infectious diseases through bites. More info: External Parasites
Heartworm: Passed through a bite of an infected mosquito and can cause serious irreversible heart and lung disease. More info: Heartworm in Dogs

Due to the changing climate and warmer winters, parasite prevention is now recommended year-round. The most complete parasite prevention covers fleas, ticks, heartworm and intestinal parasites (including tapeworm). Deworming is advised for all puppies.

Would you like to pursue parasite prevention for your puppy? *

Yes
No, I do not want any prevention today

Do you prefer topical or oral medication? *

Which parasites do you want coverage for? *

Fleas
Ticks
Intestinal parasites
heartworm

Any difficulty administering prevention previously? *

Any adverse reactions to previous preventions? *

A fecal sample is recommended for puppies, in order to check for the most common intestinal worms and parasites. If you would like us to run this, please bring a fresh stool sample (<24h old) with you to your appointment. *

I understand

Please let us know any further information on what’s important to you for your puppy’s health, including observations, questions or concerns to address at your appointment.

Thank you for taking the time to fill out this questionnaire. We look forward to meeting you at your appointment!
- The Whitehills Team

New Puppy Form

New Puppy Form

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Nutrition and Lifestyle:

Preventative Care

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