Hebron Cat Hospital

1617 W. Hebron Pkwy
Carrollton, TX 75010-6334

(972)394-9228

www.hebroncathospital.com

 

Vomiting and Diarrhea Form

 

Vomiting and diarrhea are two of the most common symptoms that our animals display. There are multiple different causes of these symptoms, and treatment varies depending on these causes. Filling out this form will help us to treat your pet more quickly and more effectively, so please be as thorough as possible with your answers.

Please fill out a new client form and/or a drop-off form as well if you would like to leave your pet with us for the day.

If you would like, we also have printable forms available for you to print out and bring in with you.

Vomiting and Diarrhea Form

Name (required)
First Name (required)
Last Name (required)
Pet's Name (required)

Phone Number (where you will be available today) (required)
Phone TypePhone Number (required)
Alternate Phone Number
Phone TypePhone Number
Has your pet been fed any table scraps or human food in the last 5 days?
yes
no


If so, what?

Is your pet acting lethargic?
yes
no


Duration:

Does your pet have a decreased appetite or dull attitude?
yes
no


Duration:

Is your pet on heartworm prevention?
(revolution, sentinel, heartgard)
yes
no


If so, what type and when was the last dose?

Is your pet on any medications?
yes
no


List any medications with dosages (please list supplements as well)

Does your pet have any previous medical conditions?

Has your pet gotten into the trash recently?
yes
no


Has your pet had any access to any chemicals?
(rat poisoning, medications, other drugs or cleaning solutions)
yes
no


If so, what?

Does your pet chew or play with any non-food items?
(thread, yarn, shoelaces, plastics, fabric, etc)
yes
no


If so, what does your pet typically chew on?

Vomiting:
When did the vomiting start?

How many episodes today have there been?

Have you noticed any blood or coffee-ground-type substance in the vomit?
yes
no


Diarrhea
When did the diarrhea start?

How many episodes today have there been?

Have you noticed any blood?
yes
no


Does the stool appear black or tarry?
yes
no


Has your pet been straining to defecate?
yes
no


Has you pet been having frequent episodes of diarrhea?
yes
no


Thank you for helping us gather as much information as possible before seeing your pet.

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