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Home
About
Our Veterinarians
Our Care Team
Photo Gallery
Hospital Tour
Reviews
Patient of the Month
Special Offer
Care to Share
Services
All Services
Wellness & Vaccinations
Allergies & Dermatology
Nutrition & Weight Management
Diagnostics
Dentistry
Surgery
Regenerative Medicine
Emergency Care
Cancer Treatment
Laser Therapy
End of Life Care
Orthopedic Surgery
TPLO
FHO
Laparotomy Procedures
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Triage Forms
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Urinary Issues Triage Form
Owner's Name:
Pet's Name:
Species:
Dog
Cat
Spayed or Neutered?
Yes
No
Age:
Best way to contact owner:
Primary Concerns
What type of urinary issues is your pet experiencing?
Frequent urination
Difficulty urinating
Blood in urine
Straining to urinate
Inappropriate urination
Excessively licking
When did you first notice the urinary issues?
Symptoms Details
How often is your pet urinating?
More frequently
Less frequently
Is your pet showing signs of pain while urinating?
Is your pet drinking more or less water than normal?
Change in volume of urine?
More urine
Small amounts
Does your pet seem to be uncomfortable or in pain?
Medical History
Has your pet experienced urinary issues in the past? If yes, describe:
On any medications and dosages?
Any known allergies?
Major surgeries or illnesses? If yes, describe:
Does your pet have any behavioral issues we should know about?
Diet
What type/ brand of food does your pet eat?
Has there been any change in your pets diet or eating habits?
Additional
Is your pet experiencing any of the following:
Vomiting
Diarrhea
Lethargy
Weight loss
Dehydration
Fever
Is there anything else you would like us to know about your pets condition?
Submit
Please do not fill in this field.
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