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Recheck Intake Questionnaire – Surgery
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Recheck Intake Questionnaire - Orthopedic
Owner Name (First and Last)
*
Pet Name
*
When walking on a leash, is your pet bearing weight on the surgery leg? (Yes/No; If "No", please provide an explanation.)
*
Are you doing PROM stretches? (Yes/No; How many times a day?)
*
Are you applying ice/heat? (Yes/No; How many times a day? How long?)
*
If instructed to do so, how many times a day is the patient going on leashed walks? How long are these walks?
*
Is your pet eating normally?
*
Are bowels movements normal?
*
Urination is normal?
*
Any vomiting?
*
Any diarrhea?
*
Has the cone we provided been on at all times? If No, please explain.
*
Is your pet taking all medications as prescribed? If no, please list medication and the reason why not.
*
What type of confinement are you doing? (Example: crate, pen, etc; plus # hours per day)
*
Do you have any concerns or questions you wish addressed at your recheck appointment?
*
New Clients
About Us
Meet Our Team
Patient Photo Gallery
Services
Surgery
Canine Rehabilitation
Patient Resources
FAQ (recovery/post-op)
Surgery Information
Surgery Prices
Payment Plans
Rehab Prices
Post-Operative Instructions
Pet Insurance
Helpful Videos
Medication Tracker
Online Forms
New Client Registration Form
Recheck Intake Questionnaire – Surgery
Recheck Intake Questionnaire – Ortho
Intake Questionnaire – Consult
Contact Us