Acute Neurological Dysfunction

PET INFORMATION


Species: DogCat

CLIENT INFORMATION
PLEASE ANSWER THE QUESTIONS ON THIS PAGE AS COMPLETELY AS POSSIBLE. OFTEN SIGNIFICANT CLUES TO YOUR PET’S NEUROLOGICAL PROBLEMS MAY BE GLEANED FROM THE HISTORY. IF YOU ARE UNSURE PLEASE INDICATE THAT FACT.

For example “I was getting his dinner ready & he got really excited, he started acting strange, shivering, trembling, then fell over and his legs were paddling and he was drooling & he peed. It lasted about 20 seconds and then he lay there and after about a minute he got up but seemed groggy for about another 10 minutes” is much more helpful than “Had a fit” (required)

Is your pet up to date on it’s Rabies vacine?
YesNoUnsure

Does your pet go outside?
YesNo

If so, are they ever unsupervised?
YesNo

Do they sometimes run free?
YesNoUnsure

Has your pet been exposed to any rat, mouse, mole or gopher bait?
YesNoUnsure

Has your pet been exposed to any mice or rats?
YesNoUnsure

Is your pet much of a hunter?
YesNoUnsure

Has the lawn been treated in the last 24-48 hours? If so, would your pet have walked through the grass?
YesNoUnsure

Have your neighbor’s treated their lawn recently?
YesNoUnsure

Have you or a neighbor treated the garden with a slug or snail poison?
YesNoUnsure

Have you used a flea or tick product(s) recently?
YesNoUnsure

Have you used any household or garden insecticides recently?
YesNoUnsure

Was your residence built prior to the 50s?
YesNoUnsure

Has your pet chewed linoleum or rug padding recently?
YesNoUnsure

Has your pet had access to antifreeze recently?
YesNoUnsure

Are there any batteries missing that you know of?
YesNoUnsure

Would your pet ingest a foreign (non-food) object?
YesNoUnsure

Is there any chance your pet could have eaten a golf ball?
YesNoUnsure

Is there any chance your pet could have eaten lead fishing sinkers? Lead pellets or shot?
YesNoUnsure

Children’s toys made in China?
YesNoUnsure

Is there any chance your pet could have eaten window putty?
YesNoUnsure

Window caulking or roofing material?
YesNoUnsure