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Inappropriate Urination or Defecation Exam

BOOK A VISIT

We look forward to seeing you!

Please complete our Inappropriate Urination or Defecation Exam Form before your visit. If you have any questions, please feel free to contact us!

Pet Parent's Name *

First

Last

Primary Phone *

Secondary Phone

Preferred method of contact *

Call
Text

Email *

Pet's Name *

My pet lives: *

Indoors
Outdoors
Both

Species *

Dog
Cat

Regular diet (brand and type) *

Amount fed per day *

How long has your pet been on his/her current diet? *

Do you give your pet any treats? *

Yes
No

What kind? *

Do you give your pet any people food? *

Yes
No

What kind? *

Indicate any applicable health symptoms and their severity.

Weight *

Gain
Loss
No change

Is the change in weight: *

Mild
Moderate
Severe

How long have you noticed the problem? *

Appetite *

Increase
Decrease
No change

Is the change in appetite: *

Mild
Moderate
Severe

How long have you noticed the problem? *

Drinking *

Increase
Decrease
No change

Is the change in drinking: *

Mild
Moderate
Severe

How long have you noticed the problem? *

Activity level *

Increase
Decrease
No change

Is the change in activity level: *

Mild
Moderate
Severe

How long have you noticed the problem? *

Urinating *

Increase
Decrease
No change

Is the change in urination: *

Mild
Moderate
Severe

How long have you noticed the problem? *

Urinary accidents? *

Yes
No

How often? *

When was the first accident? *

Where? *

Fecal accidents? *

Yes
No

How often? *

When was the first accident? *

Where? *

Difficulty walking/jumping/posturing to potty? *

Yes
No

How long have you noticed the problem? *

Any new pets in the house? *

Yes
No

Type *

When? *

Have you changed brands of litter? *

Yes
No

When? *

Have you moved or changed the litter box? *

Yes
No

When? *

Has their potty routine or access to outside changed? *

Yes
No

When? *

What changed? *

Is your pet on heartworm prevention? *

Yes
No

Brand *

Last dose given *

Is your pet on flea and tick prevention? *

Yes
No

Brand *

Last dose given *

Is your pet currently taking any medication? *

Yes
No

Please list any medications your pet is currently taking (include name, dosage, and frequency) *

Please list any existing medical conditions.

Any other problems or concerns?

Do you authorize Eno Animal Hospital to perform diagnostics and/or treatment as deemed necessary and appropriate by a veterinarian up to $200? *

Yes
No, call me first

Do you have your pet's medical records? *

Yes
No

Upload Records *

Click or drag files to this area to upload. You can upload up to 5 files.

Signature *

Date *

Does your healthy pet need a dental cleaning? Join the Eno Cleaning Club!
For a discounted rate plus lots of perks. Click here for details.

Eno Animal Hospital - pet dental month

Say hello!

We’d love to hear from you!

Name *

First

Last

Email *

Phone

How can we help you? *

Phone

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Call Us

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Visit Us

116 Goodwin Road, Durham, NC 27712

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Email Us

frontdesk@enoanimalhospital.com

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