Preventative Questionnaire Name* Patient Name Last Name Date* Date Format: MM slash DD slash YYYY Preventative Questionnaire:Are you interested in Insurance or Preventative Programs for your pet?*YesNoIs your pet on total parasite prevention?*YesNoIf yes which ones do you use?If no, why not?Facts: Parasites can cause diarrhea, weight loss and skin irritation. Many pet parasites are contagious to humans. According to a study from Auburn University Veterinary School 42% of our pets in the southeastern United States have parasites.Has your pet had a blood test in the last 12 months?YesNoFacts: A yearly blood test will pick up many of the medical conditions that occur in pets before signs of illness occurs.Would you be interested in information about preventative care and recommended food for your pet’s teeth?YesNoFacts: Tooth decay and gum disease is the most common medical problem that Veterinarian’s see. Regular teeth cleanings will remove the odor from the mouth, make your Pet feel better, and will prevent costly extractions as your pet ages.