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Dog Health Questionnaire
First Name
Last Name
Dog(s) Name
Phone Number
Email
What is your primary concern for your dog?
What is your goal for taking the workshop?
What is your dog's exercise routine?
Does your dog have any current medical issues?
Has your dog had any previous injuries or surgeries?
Do you give your dog any supplements or medications?
What kind of diet is your dog on? (Kibble, Wet, Dry, Whole Food, Raw)
Does your dog have a good appetite?
Yes
Has a history of being a picky eater
No
Is your dog fed at ground level or elevated?
Ground
Elevated
Any GI issues? (Vomiting, Diarrhea)
Any urinary issues?
Who is your dog's regular Veterinarian?
How old is your dog? (approximate guess is fine)
How long have you had your dog?
What breed (or breed mix) is your dog?
Where did you get your dog?
Breeder
Rehome
Rescue
Discipline/Sport?
Pet
Agility
Show
Bite sports
Hunting
Other
In the last week, has your dog been active?
Yes
No
In the last week, has your dog had a good willingness to play?
Yes
No
In the last week, have you seen your dog limp?
Yes
No
In the last week, has your dog been sleeping comfortably?
Yes
No
Does your dog have difficulty going on a walk?
Yes
No
Does your dog have any difficulty running?
Yes
No
Does your dog have any difficulty rising from sitting/laying down?
Yes
No
Does your dog have difficulty navigating the stairs?
Yes
No
Does your dog have any difficulty getting on or off furniture/bed?
Yes
No
Does your dog have any difficulty getting in and out of the car?
Yes
No
Does your dog have any difficulty squatting to urinate/defecate?
Yes
No
Does your dog yawn?
Yes
No
Not Sure
Does your dog do the 'downward dog' stretch?
Yes
No
Not Sure
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