Village Animal Hospital & Bird Clinic 1340 Palm Bay Rd. N. E., Palm Bay, FL 32905 Tel (321) 725-9770 - Fax (321) 724-9604

Owner   _______________   Date   _______________     Pet   __________   Wt.   __________   Dr.   __________

Coat and Skin __appears normal  __infect/staph/yeast  __parasites  __allergic  __itchy  __thinning  __dry  __oily  __tumors recommendations __________________________________________________________________ Eyes __appear normal  __dry eye L/R  __pressure abnormal L/R  __ageing lens L/R  __infection L/R __tumor L/R    __cataract L/R    __inflamed L/R    __ulcer L/R recommendations __________________________________________________________________ Ears __appear normal    __infection bacteria L/R    __tumor L/R    __allergy L/R    __infection yeast L/R __wax L/R    __inflamed L/R    __mites recommendations __________________________________________________________________ Nose and Throat __appear normal    __nasal discharge    __tonsils large    __coughing    __nasal inflammation __lymph nodes large      __throat inflamed recommendations __________________________________________________________________ Mouth, Teeth and Gums __appear normal      __broken teeth      __loose teeth      __cavities      __exposed nerves __infection      __rartar      __gingivitis      __periodontal disease      __tumor recommendations __________________________________________________________________ Lega and Paws __appear normal  __lameness L/R front/rear  __joint disease L/R front/back  __nail disease L/R front/rear recommendations __________________________________________________________________ Anal Sacs __appear normal      __infected L/R      __abscess L/R      __tumor L/R recommendations __________________________________________________________________ Heart __appears normal      __irregular beat      __heart murmur      __too slow / too fast recommendations __________________________________________________________________ Lungs __appear normal  __abnormal sounds  __breathing difficulty  __congestion  __coughing  __rapid breathing recommendations __________________________________________________________________ Abdomen __appears normal      __abnormal mass      __enlarged organ(s)      __fluid      __tense/painful recommendations __________________________________________________________________ Gastrointestinal System __appears normal      __appetite abnormal      __diarrhea/cogestion      __parasites      __vomiting recommendations __________________________________________________________________ Urogenital System __appears normal      __genital discharge      __mammary tumors      __prostate abnormal __testicles abnormal      __urination / bladder abnormal recommendations __________________________________________________________________ Nervous System __appears normal      __head / face affected      __leg(s) affected      __pain - spinal recommendations __________________________________________________________________