Name: Elon Oaks Veterinary Hospital
Address: 110 S Williamson Ave., Elon, NC, 27244, United States
Telephone: 336-584-3738
Price range: $

Patient History Form

Having the whole picture of your pet’s lifestyle, habits, and risk factors helps us to make recommendations that are customized to your pet’s specific needs. Thank you so much for taking the time to complete this patient history form.

Owner's Name *

First

Last

Phone *

Email *

Pet's Name *

Has your pet had any of the following abnormal clinical signs (check all that apply)?

Coughing
Sneezing
Vomiting
Diarrhea
Straining to defecate
Blood in feces
Straining to urinate
Frequent urination
Blood in urine
Abnormal appetite
Abnormal thirst
Low energy or lethargy
Itching
Excessive licking
Skin wounds
Abnormal eye discharge
Squinting
Limping
Behavior change

If yes to any of the above, please explain *

What other concerns or questions do you have about your pet’s health today?

What is your pet’s typical environment? *

Indoor only - NEVER goes outside
Primarily Indoor - Outside to potty and play
50/50 Indoor vs. Outdoor
Primarily Outdoor

Does your pet spend time in the following places (check all that apply)?

Doggie daycare
Boarding facilities
Grooming
Dog parks
Wet or muddy backyards or fields
Tall grass
Wooded areas

Are there any other pets in the home? *

If yes, please list the other pets in the home including their species *

What food or foods do you feed your pet? *

How much food do you feed your pet in one day? *

Does your pet get treats? *

Does your pet get people food or table scraps? *

What heartworm prevention does your pet receive? *

Simparica TRIO
Tri-Heart Plus
Interceptor Plus
Proheart 6
Proheart 12
Revolution Plus
None
I'm not sure
Other

If other, please specify *

What flea and tick prevention does your pet receive? *

Simparica TRIO
Simparica
Bravecto
Seresto
None
I'm not sure
Other

If other, please specify *

What medications does your pet receive?

What supplements does your pet receive?

Do you need refills on any of your pet’s medications? *

Yes
No
Not applicable

If yes, please list medications (include medication name, dosage, and quantity) *

Which of the following are part of your pet’s dental health care (check all that apply)?

Daily tooth brushing
Daily dental chews or treats
Dental water additive
Other

If other, please specify *

Do you have any additional comments or other information to share with the veterinarian prior to your pet’s appointment?

Book An Appointment

You can book an appointment online in minutes by clicking the BOOK APPOINTMENT button. It's that simple.

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Small dog lying down next to a red frisbee in the grass

How to contact us:



Call

336-584-3738



Email

[email protected]

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Address

110 S Williamson Ave.
Elon, NC 27244



Hours

Mon: 8 am - 5:30 pm
Tues: 8 am - 5:30 pm
Wed: 8 am - 5:30 pm
Thurs: 8 am - 5:30 pm
Fri: 8 am - 5:30 pm
Sat: 8 am - 5:30 pm
Sun: Closed

Send us a message!

Have a question for our team? Don't hesitate to reach out with questions big or small. If you need immediate assistance, please call us directly at 336-584-3738 during business hours.

Name *

First

Last

Email *

Phone

How can we help you? *

Name

Ready for a visit?

We are so excited to see you soon. You can book an appointment online in minutes by clicking the BOOK APPOINTMENT button. It's that simple.

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