Castle Peak Veterinary Service (970)-328-5444 / (970)926-1812 Drop Off: Fecal and Urinalysis to best serve you and your pet, please print & fill out this information sheet Client's Name: _______________________________ Pet's Name: _______________________ Best Phone # to reach you: Today_________________ Tonight_________________ Date:___/___/___
Please fill out this section for all fecal and urine samples: - Time sample was obtained:______________________ - Circle one: 1st time / Recheck / Wellness - Days abnormal:___________________________________________________________________________ - Currently on medication? YES / NO - What medication?_________________________________________________________________________ - Any improvement? YES / NO - What are you currently feeding your pet?______________________________________________________ - Any recent changes in food or snacks?_________________________________________________________ - Eating: LESS / NORMAL / MORE Drinking: LESS / NORMAL / MORE Energy: DOWN / NORMAL - Comments or concerns:____________________________________________________________________ ___________________________________________________________________________________________
Fecal Sample: - Stools appear: FIRM / SOFT / RUNNY - Vomiting: YES / NO - Eat mice / birds / game? YES / NO - Exposed to river / pond water? YES / NO - Recently eat something unusual? YES / NO - Accidents in the house? YES / NO
Urine Sample: - Urinating in peculiar places? YES / NO - Pain when urinating? YES / NO - Straining while urinating? YES / NO - Increased frequency of urination? YES / NO - Blood in urine? YES / NO