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Veterinary Animal Health Checkup Survey Checklist

Ensure thorough and compassionate animal care! Our Veterinary Health Checkup Survey Checklist helps you gather vital feedback, identify areas for improvement, and build stronger client relationships. From exam room comfort to post-appointment guidance, cover every detail for happy pets & satisfied owners.

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Patient Demographics

NaN of 12

Collect basic information about the animal and owner.

Animal's Name

Animal's Breed

Animal's Age (Years)

Animal's Weight (lbs/kg)

Animal's Sex

Is Animal Spayed/Neutered?

Owner's Name

Owner's Phone Number

Initial Observation & History

NaN of 12

Record initial observations and gather relevant medical history.

Date of Last Visit

Reason for Visit (Owner's Perspective)

Current Medications?

History of Previous Illnesses/Surgeries

Estimated Age (if unknown)

Breed (if known)

Vital Signs

NaN of 12

Measure and record vital signs: temperature, pulse, respiration, weight.

Temperature (°C)

Pulse Rate (bpm)

Respiratory Rate (breaths/min)

Weight (kg)

Time of Measurement

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Measurement Technique

Physical Examination - Head & Neck

NaN of 12

Detailed assessment of the head and neck region.

Head Shape

Eyes - Symmetry

Eyes - Description of Findings (e.g., discharge, redness)

Nose - Discharge?

Mouth - TPR (Temperature, Pulse, Respiration)

Oral Cavity - Description of Findings (e.g., gingivitis, ulcers)

Lymph Nodes - Palpable?

Lymph Nodes - Description of Findings (size, consistency)

Physical Examination - Thorax & Abdomen

NaN of 12

Detailed assessment of the chest and abdominal areas.

Heart Rate (bpm)

Heart Rhythm

Respiratory Effort

Respiratory Rate (breaths/min)

Abdominal Palpation

Abdominal Auscultation Notes

Physical Examination - Musculoskeletal

NaN of 12

Evaluate musculoskeletal system: gait, posture, range of motion.

Weight (kg)

Gait Observation

Postural Assessment

Range of Motion (Shoulder - Degrees)

Range of Motion (Hip - Degrees)

Musculoskeletal Abnormalities (if any)

Physical Examination - Skin & Coat

NaN of 12

Assess skin condition, coat quality, and any abnormalities.

Coat Type

Coat Condition

Describe Coat Texture

Skin Lesions Present?

Number of Skin Lesions

Detailed Description of Skin Lesions (location, size, appearance)

Upload Skin Lesion Photos (if applicable)

Presence of Parasites?

Ophthalmological Examination

NaN of 12

Assessment of eyes and vision.

Pupil Size (Right)

Pupil Size (Left)

Pupillary Light Reflex (Right)

Pupillary Light Reflex (Left)

Visual Acuity (Right - if applicable)

Visual Acuity (Left - if applicable)

Ocular Abnormalities/Findings

Aural Examination

NaN of 12

Evaluation of ears and hearing.

Ear Canal Appearance

Discharge Type (if present)

Cerumen (Earwax) Amount

Pinna Temperature (°C)

Additional Aural Exam Notes

Sensitivity to Palpation?

Diagnostic Tests (if applicable)

NaN of 12

Record any diagnostic tests performed and results (e.g., bloodwork, urinalysis).

Bloodwork Requested?

CBC - White Blood Cell Count (WBC)

Chemistry Panel - Glucose (mg/dL)

Urinalysis Requested?

Radiology Notes (if applicable)

Fecal Exam Requested?

Treatment Plan & Recommendations

NaN of 12

Outline the proposed treatment plan and any recommendations for the owner.

Detailed Treatment Protocol

Medication Dosage (mg)

Medication Route

First Medication Administration Date

Duration of Treatment (Days)

Follow-Up Appointment Type

Next Appointment Date

Owner Education & Follow-Up

NaN of 12

Document any owner education provided and schedule follow-up appointments.

Summary of Key Points Discussed with Owner

Next Appointment Date

Next Appointment Time

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Medication Instructions Provided?

Dietary Recommendations Provided?

Follow-up Appointment Cost Estimate

Owner Understanding of Plan?

Additional Notes/Instructions for Owner

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