Contact
Cardiology Form
Emergencies
Online Store
808-329-8999

Home
About Us
Services
Pet Care
Pet Travel

Home
About Us
Services
Pet Care
Pet Travel

Pet Cardiology Questionnaire

"*" indicates required fields

Pet's Name*

What are your main concerns? How long have the problems been present?*

Symptoms

Is your pet coughing?*

Yes

No

How many times a day?*

How many coughs per episode?*

Is the coughing getting worse?*

Yes

No

Not sure

Are you measuring your pet’s sleeping respiratory rate (breathing rate)?*

Yes

No

See: How to monitor sleeping respiratory rates at https://youtu.be/f4SBwD4JzFQ

Highest sleeping respiratory rate*

Lowest sleeping respiratory rate*

Does your pet have a decrease in energy?*

Yes

No

When did this start?*

Is it getting worse?*

Yes

No

Not sure

What was your pet doing before and during the event?*

Has your pet ever collapsed or had sudden weakness?*

Yes

No

How long was the actual event?*

How long until completely back to normal?*

How many times has this happened?*

Diet

What is your pet’s diet?*

Is this a Grain-Free diet?*

Yes

No

Not sure

Has there been a change in appetite?*

Yes

No

Has there been a gain or loss of weight in the last 3 to 6 months?

Yes

No

Not sure

Medication

Is your pet on flea medication?*

Yes

No

Is your pet taking any heartworm preventatives?*

Yes

No

Is your pet taking any other medications?*

Yes

No

How has your pet responded to these medications?

Does your pet have any drug or environmental allergies?

Flea Medication

Name

Strength (mg)

Tablets given

Frequency

Heartworm Preventatives

Name

Strength (mg)

Tablets given

Frequency

Other Medication

Name

Strength (mg)

Tablets given

Frequency

Add additional medication?

Yes

No

Name

Strength (mg)

Frequency

Tablets given

Use this space to list any additional medications your pet is taking.

Travel

Has your pet traveled outside of Hawaii?

Yes

No

Where?

CAPTCHA

3626

Contact Us

75-349 Hualalai Road, Kailua-Kona, HI 96740

Phone:808-329-8999 | Fax: 808-329-8997

Hours

Monday-Saturday: 7am-5pm

Contact Us Online

© 2024 Alii Veterinary Hospital. Designed & Managed by ViziSites. Terms of Use.