FECAL QUESTIONNAIRE

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Client Name *

First

Last

E-mail *

Phone *

Would you prefer we provide test results by email or phone? *

Email
Phone
No Preference

Patient Name *

Patient Species *

Have you seen any worms? If so, please describe:

What is the consistency of the stool?

How long has the problem been going on?

Is your pet on Heartworm medication?

Is there a history of allergies?

What type of food do you feed?

Have you changes food brand/type recently?

Has he/she had anything to eat that is not part of the usual diet? If yes, describe:

Has he/she been on any medications? If yes, please list:

Is this a recheck to make sure the problem has been eradicated?

Yes
No

When was the sample collected?

Name

We are currently not accepting new clients.
Online appointment requests are only for existing patients in need of a routine visit. If your pet is sick or needs an urgent visit, please call or text the office at 860-774-7650.

Existing clients with a new pet are to call or text the office at 860-774-7650 to schedule an appointment.

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