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COVID-19 update: Client advice on what to do during the Coronavirus pandemic

Extended Evaluation Checklist

This form is designed to be completed by one of our vets or registered veterinary nurses, at Congleton Vets

If you are a client and have been requested to fill in the questionnaire about your pet’s nutrition, please find and complete our Diet History Form.

 

Vet {Select from}:




Nurse {Select from}:




 
Pet's species:

Pet's gender:

Is Pet Neutered?:

Today
Has the Screening Evaluation been completed?:

Changes in food intake or behaviour

Amount Eaten:

Chewing:

Swallowing:

Nausea:

Vomiting:

Regurgitation:

Condition of the integument

 
 
Easily plucked hair:

Thin Skin:

Dry or scaly skin:

 

Abnormalities in the serum chemistry profile

 
 
Glucose:


Albumin:


Total Protein:


Urea:


Creatinine:


SDMA:


TotalT4:


 

Abnormalities in complete blood count

Anaemia:

Lymphopenia:

 

Recommendations

Change in caloric intake recommended?:

kcal or kJ/day
kcal or kJ/day
Change in the diet recommended?:

Change in the feeding management recommended? :

Change of environmental factors recommended? (I.e. issues with multiple pets, other food providers and sources, extent of enrichment, activity of pet, environmental stressors.):

Recommendations for monitoring given to the client? (I.e. BW, BCS, MCS, food intake, appetite, gastrointestinal clinical signs, activity, overall appearance.):

Did the client purchase the recommended food?:

Educational Information and/or tools dispensed:

 

On completion, press SUBMIT (enquiries@congletonvets.com) where the form shall be forwarded to the relevant vet who should then communicate with the client. 

 
Security Question: