Prairie State Veterinary Clinic
100 Ravinia Place
Orland Park, IL 60462     708-349-3331

 

A Veterinary Family Practice Clinic Dedicated To Exceptional Primary Care.

Prairie State Veterinary Clinic

100 Ravinia Place
Orland Park, IL 60462

(708)349-3331

flemingvet.com

Prairie State Veterinary Clinic

100 Ravinia Place

Orland Park, Illinois  60462

708-349-3331

Comprehensive Health Exam Report

 

Pet: __________________________________________         Date:  ______________

[   ] Physical Exam:

1.  Coat & Skin

7.  Heart

□ Appear Normal

□ Pigment

□ Itchy

□ Sounds Normal

□ Arrhythmia

□ Dry/Dull

□ Lesion

□ Malted

□ Murmur

□ Other ____________________

□ Greasy

□ Lumps

□ Shedding

8.  Abdomen

□ Scaly

□ Parasites

□ Hair Loss

□   Appears Normal

Other________________

2.  Eyes

[ ] Fluid / Mass

 Appear Normal

□ Retina:  L___  R___

  

□ Discharge:  L___  R___

□ Ulcers/Lesions:  L___  R___

□ Inflamed:  L___  R___

□ Eyelid Adenoma

9.  Lungs

□ Infection:  L___  R___

□ Other ___________________

□ Sound Normal

□ Other _____________________

□ Cataract:  L___  R___

 

□ Abnormal Sound

____________________________

3.  Ears

□ Coughing

 

□ Appear Normal

□ Excessive debris L___  R___

□ Congestion

 

□ Inflamed:  L___  R___

□ Itchy

10.  Urogenital System

□ Yeast Inf.:  L___  R___

□ Other __________________

□ Appears Normal

□ Mammary Tumors

□ Bacterial Inf.:  L___ R___

_________________________

□ Abnormal Urination

□ Anal Sac Tumor Check

4.  Lymph Nodes

 

[ ]Prostate

□  Normal/Enlarged

5.  Mouth, Teeth, Gums

 

11.  Weight __________ lbs.

□ Appear Normal

□ Gingivitis (inflamed Gums)

□ Normal Range

□ Underweight

□ Broken Tooth/Teeth

□ Ulcers/Lesions

□ Overweight approx ____ lbs

Other ______________________

□ Loose Tooth/Teeth

□ Pyorrhea (pus)

Microchipped ?

□ Tarter  _____ major  _____moderate   ______minor

□ Yes

□ For your pet’s health’s sake a dental cleaning needs to be done as            soon as you can schedule it.

□ No

□ A teeth cleaning should be done within _____ to _____ months

Water Consumption Normal?

□ A teeth cleaning is not needed at this time.

□ Yes

6.  Musculoskeletal

 

□ No

□ Appears Normal

 

Normal Urination and BM?   Yes □        No □

□ Mobility Issues Y□  N□

 

Cognitive Function Change?   Yes □        No □

□ Pain on palpation

□ Stiffness

 

 

[   ]  Complete Blood Count:  See Attached Report and Comments.

[   ]   Metabolic Profile:  See Attached Report and Comments.

[   ]   Thyroid Hormone Level:  [   ] Normal         [   ] Abnormal
[   ]   Canine Basal Cortisol Level:  [   ] Normal  [   ] Abnormal

[   ]   Complete Urinalysis:  [   ] Normal              [   ] Abnormal

[   ]   Blood Pressure:  __________       [   ] Normal         [   ] Abnormal

[   ]   Intestinal Parasite Exam             [   ] Neg  [   ] Pos          ]  Giardia:  [   ] Neg    [   ] Pos 

 [   ]   Canine Arthropod Screen:           Heartworm:  [   ] Neg  [   ] Pos     Lyme:  [   ] Neg  [   ] Pos 

                                                            Anaplasma:  [   ] Neg[   ] Pos     Ehrlichia:  [   ] Neg   [   ] Pos 

[   ]   Feline Leukemia Virus:  [   ] Neg   [   ] Pos      Feline Aids Virus:  [   ] Neg   [   ] Pos   

[   ]   Chest X-Ray:  [   ] Normal      [   ] Abnormal  (see attached report)

[   ]   Electrocardiogram:  [   ] Normal        [   ] Abnormal (see attached report)

[   ]   Nail Trim and Ear Cleaning                [   ]  25% Discount of a dental cleaning within 1 year

[  ]    Written Report & Recommendations