Date *

Pet's Name *

Owner's Name *

First

Last

Primary Contact Phone *

Secondary Contact Phone

E-mail *

**Please be aware questions continue on the back of this form.**

A DAH full annual exam includes the following:

A nose-to-tail full physical exam performed by one of our DVMs
Routine core vaccine boosters: Rabies, Da2ppL (distemper, parvo, leptospirosis), Bordetella
- Depending on your pet’s age and last Da2pp vaccine, they may only require Leptospirosis
Fecal check for intestinal parasites like roundworms, hookworm, whipworms, and coccidia
Heartworm check – required to purchase heartworm preventatives

We strongly recommend yearly bloodwork that includes a heartworm test. Yearly bloodwork allows us to evaluate your pet’s organ function and catch trends that might be indicative of diseases or metabolic conditions before we start to see clinical signs. When caught early, we have a better chance of being impactful with treatment rather than after we begin to see clinical signs.

Please circle what you approve in the following sections:

Do you approve all core vaccines your pet is due for? *

Yes
No

If no, what vaccines do you approve?

If your pet has ever had a vaccine reaction, please describe what kind of reaction

Do you request any non-core vaccines be boostered?

Would you like? *

Heartworm
YEARLY BLOODWORK with Heartworm

Yearly bloodwork that includes a heartworm check is sent out to our reference lab Antech and results will be sent to us typically in 24-48hrs. Once we receive results, we will call you!

What heartworm and flea/tick preventions are your pet on?

If your pet has been on ProHeart injection for heartworm prevention, do you wish to continue with that prevention?

Yes
No

If yes, do you approve the 6 month or 12 month injection?

If your pet has been on Nexgard Plus, do you need more at pick-up today?

If your pet is on another prevention, do you need an Rx on our online pharmacy?

What food does your pet eat?

Do you? *

Free Feed
Schedule Feedings (twice a day)

Do you measure your pet’s food? *

Yes
No

If so, what do you measure your pet’s food with?

Below please include any concerns you may currently have regarding your pet you would like addressed during their annual exam:

Would you like any additional treatments performed: *

Nail trim
Clean Ears
Express anal glands (will only be performed if p has been scooting or has needed them expressed in the past, they will be assessed prior to expression)
Other

Other

Thank you! We will call you when your pet is ready to go home!

Owner’s Signature *

Clear Signature

Date *

Canine Annuals Drop-Off Form

Canine Annuals Drop-Off Form

Have a question?

Contact Delta Animal Hospital

Have a question?

Address

Contact

Hours