MetroVet St. Louis Patient History Form Please fill the form below to enter your new patient history form. Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *PhonePet Name *Do you have any health or behavior concerns? *YesNoIf yes, please describe and tell us for how long this has been going on. How is their attitude and behavior? *NormalLethargicHyperactiveHow is their appetite? *NormalIncreasedDecreasedWhat type of food are they eating (brand and type)? *Please check any of the following symptoms that you’ve observed recently:VomitingDiarrheaCoughingSneezingItchy Skin or PawsNew lump or bumpHead ShakingScratching EarsLimpingLamenessMobility IssuesEye DischargeIncreased Thirst/DrinkingIncreased UrinationUrinating or Defecating Outside the Litter Box (cats)OtherIf necessary, please tell us more about any of the symptoms you chose in the last question. Please list all medication, supplements, and parasite preventions they are currently taking (type ‘none’ if not applicable).Are there any medication/supplement/parasite preventatives you would like us to refill for you? One key to helping our pets live a long, healthy, and happy life is early detection of disease or illness. For pets over the age of 4 years, we recommend performing annual bloodwork to aid in this early detection and to get a “baseline” should we need to compare bloodwork results in the future. Estimated cost for annual bloodwork is approximately $100-$180. Click here to learn more about what we evaluate on this bloodwork. Would you like us to run wellness bloodwork at your pet’s upcoming appointment? *YesNoNot Sure YetNameSubmit
