Mazomanie Animal Hospital

704 Emily Rd
Mazomanie, WI 53560

(608)795-4242

www.mazoanimalhospital.com

Puppy Check-In Form

Thank you for scheduling a Puppy Exam! We hope your are enjoying your new puppy!
We are here to help you get off on the right paw.

At each puppy visit (usually at 8,12 and 16 weeks of age), we will be examining your puppy for health concerns as he/she rapidly changes and grows.
We will also review our recommendations to prevent, manage, or treat many common behavioral and medical problems common to dogs. 
These recommendations are specifically outlined in the New Puppy Handout you will be provided at your puppy's first visit.  

Please fill out the form below to help us best serve you and your puppy during their visit.

Thank you for your time!

Puppy Check In Form Form

Email (This should be the main email you would like us to use for your account) (required) :
Puppy's Name (required)

Owner's Name (That account is under in our system) (required)

Who will be bringing your puppy to their appointment? (required)

What is the best contact number for that person? (required)

Address
Street Address
City
,		State / Province
Zip / Postal Code
Phone
Phone TypePhone Number
Is this a cell phone that can accept text message reminders from us?

Yes
No


To help us focus on your particular areas of concern at today's visit, please answer the following questions.
Have you personally cared for and raised a young puppy in the last 5 years?

Yes
No


Are there any other pets in the household?

Yes
No


How long have you had this new puppy?

Where did you get this puppy?

Humane society / shelter
Breeder
Stray
Rescue Organization
Other (Please describe in Other Comments box below)


Does your puppy have any MEDICAL problems you are concerned about today?

Itchy ears or skin
Stools abnormally soft or diarrhea
Poor appetite
General nutrition or feeding questions
Other (Please describe in Other Comments box below)


Are you experiencing any of the following common puppy TRAINING problems?

Socialization with children or other dogs
House training or submissive urination
General obedience training
Play biting / "Mouthiness"
Overly aggressive play / pushy behavior
Jumping on people
Crate training problems
Other (Please describe in Other Comments box below)


All dogs benefit from regular oral home care (Teeth brushing). Would you like us to advise you on how to start training your puppy so teeth brushing can become a quick, simple procedure?

Yes
No


Would you like your puppy's nails trimmed today? (There is a fee for this)

Yes
No


Do you have any particular Flea/Tick Preventions you intend to use or are interested in using?

8 month collar
Topical spot-on
Oral once monthly Chew
Other (Please describe in Other Comments box below)


Other Comments / Questions


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