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We're here for emergencies 24 hours a day, 7 days a week!
Hours & Contact
Hickory Veterinary and Specialty Hospital
P:
(610) 880-3534
[email protected]
Hospital Hours: Open 24 Hours, 7 days a week
Pharmacy Hours: 8am - 8pm
Pharmacy:
(610) 825-1079
Hickory Pet Inn
P:
(610) 600-1676
[email protected]
Mon-Sat: 8:00am - 5:30pm
Sunday: 11:00am - 5:30pm
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Feline Behavior Recheck Appointment
Cat Recheck History
Patient's Name
Breed
Age
Gender
- None -
Female Spayed
Male Nuetered
Female Intact
Male Intact
Date of Birth
Owner's Name
Street Address
City, State, Zip
City/Town
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- None -
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Armed Forces (Canada, Europe, Africa, or Middle East)
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Guam
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Utah
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Virginia
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ZIP/Postal Code
Primary Phone
Secondary Phone
Who is your primary veterinarian?
Your Email
What is the primary problem being rechecked?
What are your goals for this recheck consultation? (Please be specific)
Behavior Medications
Medication
Dose
List Side Effects
How Severe
- None -
None
Mid
Severe
Response to Medication
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Medication
Dose
List Side Effects
How Severe
- None -
None
Mid
Severe
Response to Medication
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Medication
Dose
List Side Effects
How Severe
- None -
None
Mid
Severe
Response to Medication
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Medication
Dose
List Side Effects
How Severe
- None -
None
Mid
Severe
Response to Medication
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
New Behavioral Problems
Describe the problem
Severity of Problem
Extremely Serious
Very Serious
Serious
Somewhat Serious
Not Serious
Describe the problem
Severity of Problem
Extremely Serious
Very Serious
Serious
Somewhat Serious
Not Serious
Describe the problem
Severity of Problem
Extremely Serious
Very Serious
Serious
Somewhat Serious
Not Serious
Describe the problem
Severity of Problem
Extremely Serious
Very Serious
Serious
Somewhat Serious
Not Serious
Pre-Existing Behavioral Problems
Describe the problem
Improvement of Intensity
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Improvement of Frequency
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Describe the problem
Improvement of Intensity
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Improvement of Frequency
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Describe the problem
Improvement of Intensity
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Improvement of Frequency
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Describe the problem
Improvement of Intensity
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
Improvement of Frequency
Worse
Same
<25% Better
25-50% Better
50-75% Better
75-90+% Better
If your pet has developed any new behaviors, either desirable or undesirable, please describe them
Please give us a detailed description of recent representative events of each current problem. Please include the location, dog’s body postures, any people present, any triggers, your reaction, and the final outcome.
Have there been any changes in your household since your last appointment?
YES
NO
If so, what has changed?
Family moved to new home
Family schedule changed
Pet Added
Death/Relinquishment of other pet
Death of a household member
Departure of a household member
Arrival of a new household member
Marriage
Divorce
Birth/Adoption of a child
Other
If you checked "other" please describe
Does your pet respond differently to one family member than to others? Has this changed since your last visit? If so, please describe:
Current Management
How are you handling specific situations with respect to the problems listed above, e.g., confining your pet when visitors arrive, using window films, getting a pet sitter when you go to work? How does your pet react? Do you feel this is working?
Please indicate below what recommendations you have implemented what what was the outcome:
Recommendation
Outcome
Recommendation
Outcome
Recommendation
Outcome
Recommendation
Outcome
Are you, any family member, or your pet having difficulty with any parts of your discharge instructions, or are there any recommendations you have been unable to implement? Please explain fully.
Any additional comments about your pet's training?
Have you recently considered finding another home for this pet?
Yes
No
Have you recently considered euthanasia? (putting your pet to sleep)
Yes
No
Has someone recently recommended that you euthanize your pet?
Yes
No
Has the behavior service helped you with your pet?
Yes
No
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