Name First Name Last Name Your pet's name * Please choose appropriate lifestyle option below: * Indoor only! Indoor and outdoor! How long has your dog been vomiting? * Less than 24 hours 1-2 days 3-7 days More than a week How often has your dog vomited in the past 24 hours? * 1-2 times 3.-5 times 6+ times What does the vomit look like? * Clear or frothy liquid Yellow or bile Food present Hairballs Blood-tinged (red or dark coffee-ground appearance) Have you noticed any of the following symptoms along with vomiting? * Diarrhea Lethargy or weakness Loss of appetite Increased thirst Increased urination Bloated or distended abdomen Drooling Coughing or sneezing Change in behavior or hiding Weight loss Abdominal pain (whining, hunching, sensitivity when touched) Have there been any changes in your dog’s diet recently? * Yes No If yes, please describe the new food, treats, or changes: Does your dog tend to eat too fast or throw up right after meals? * Yes No Is your dog currently on any medications or supplements? * Yes No If yes, please list them and when they were last given: Does your dog have access to any toxins or potential hazards? (e.g., plants, chemicals, small objects) * Yes No Unsure Has your dog had any history of vomiting or gastrointestinal issues in the past? Yes No Has your dog been diagnosed with any other medical conditions (e.g., kidney disease, pancreatitis)? Yes No Unsure Is your dog up to date on flea prevention and other regular veterinary care? Yes No Is there anything else you’d like to mention regarding your dog’s health or recent changes? Has your dog been exposed to new environments or stress (e.g., travel, new pets, recent moves)? * Yes No Unsure Has your dog ingested any foreign objects (e.g., bones, toys, garbage)? * Yes No Unsure Thank you!
