Please list all medications your pet has taken within the past 3 months and/or is currently taking. List the name of the medication, strength of the medication, and how many times a day you give the medication. Example: Pimobendan 5 mg twice daily. Hartgard 10-20# once a month.

Indicate compounded or liquid amounts by concentration. Example: Amoxicillin suspension 100 mg/ml 1 ml every 12hours. Furosemide 5 mg/chew Give 1 chew every 8 hours

If you are unable to complete this form, arrive 30 minutes prior to your appointment, bring all medications with you at the time of your visit and we will help complete this list.