Dental Evaluation Questionnaire

We’re excited to welcome your pet to the Woodland Veterinary Hospital. Our Dental Evaluation Questionnaire helps our team gather important information about your pet’s dental and overall health before their visit.

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Complete the Dental Evaluation Questionnaire

Contact Name *

First

Last

Phone Number *

Email Address *

Pet's Name *

Is there a specific concern that prompted you to schedule a dental evaluation for your pet?

Does your pet have any general health issues?

What type and how much food does your pet eat?

Are there any changes to your pet's energy level?

Are there any changes to your pet's food or water intake?

Does your pet currently take any medication or supplements? If so, please list.

Do you currently do anything at home to care for your pet's teeth? If so, please list.

If you prefer to wait curbside during your pet's appointment, what is the best phone number to call you at while you are in our parking lot?

If you choose to remain curbside, what is the model and color of the vehicle you will be waiting in?

Some of our doctors use an AI scribe to assist with medical records. Is it ok for them to audio record your exam?

Yes
No

Today's Date *

Signature

Clear Signature

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