Glastonbury CT Vet

Farm Animal Check-In Form

Please fill out the following information to help us better identify area of concern.

Client

Patient

Breed

Sex

Age

 

What does your animal eat? (please include brand, frequency, amount given, type of hay & amount)
   

When was the last time your animal's feet were trimmed?
 
  

When was your animal last dewormed and with what product?


 

Do any of the following describe your animal's current history? CHECK all that apply.

Have you added any new animals to your herd

Abnormal urination or defecation (straining)

Have you changed feeds or hay or recently put animal(s) on pasture

Diarrhea

Do you rotate pasture?
How often?

Abnormal appetite (increased or decreased)

Hairloss or abnormal shedding

Abnormal drinking (increased or decreased)

Itchiness / increased scratching / rubbing on things

Abnormal chewing / swallowing

Hives or other abnormal lumps

Cough

Discharge from nose or eyes

Sneezing / abnormal breathing

Lameness / limping

Abnormal odor from nose or mouth

Abnormal odor from foot (feet)

Other

 

Do we have your permission to use a picture of your animal for our marketing campaigns? Yes     No

 

Please be sure to fill out as much information as possible before sending.