Complete your annual lifestyle survey online. Save time during your next visit by completing your annual lifestyle survey online before your next appointment. We look forward to seeing you soon! Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Are you or anyone in your household 65 years of age or older?YesNoPlease list all additional pets and their species here:Do you use flea and tick control products?YesNoProduct(s) used:Do you treat all pets in the household?YesNoWhen was the last dose given/applied?Do you give it year round?YesNoDo you forget to administer?OccasionallyFrequentlyNeverDo you use heartworm prevention products?YesNoProduct(s) used:Do you treat all pets in the household?YesNoWhen was the last dose given/applied?Do you give it year round?YesNoDo you forget to administer?OccasionallyFrequentlyNeverDo you use dental products?YesNoHow often?DailyWeeklyOccasionallyRarelyPlease list any and all medications:Please list any and all vitamins/supplements:General health concerns (please check all that apply):My pet has lost or gained weight recentlyMy pet's behavior or activity level has changedMy pet's behavior while urinating or defecating has changedMy pet's skin or hair coat has changedMy pet seems painful, weak, or exhibits tremorsMy pet seems itchyWhich places does your pet go? (please check all that apply):Indoor OnlyNeighborhoodPorch/Patio/DeckObedience/Training classesKennel/DaycarePet storesHiking, hunting, camping, fishingCommunal areas (condo)Dog ParksGroomingTravel with familyForest preservesBackyardWhere do they travel to?Do you observe wild animals or other wildlife in your neighborhood? (please check all that apply):Feral catsSquirrels, chipmunks, skunks, small rodentsRaccoons, opossumDeerRabbitsWild fowl (turkeys, geese, ducks)Wild canines (coyotes, foxes)OtherWhich of the following is true? (please check all that apply):Other pets come into our homeOther pets come into our yardMy pet visits other homes with petsWe feed our pets outsideWe feed wild animals/feral catsWe have seen parasites on our pet(s) previouslyI feed my pet:DryCannedBothWhat brand and flavor of diet do you feed your pet? How much and how often? How much exercise does your pet get daily?Does your pet get treats? What kind and how many?Additional concerns you would like to discuss:PhoneSubmit