Patient Recheck Form - University of Georgia College of Veterinary MedicineUniversity of Georgia College of Veterinary Medicine

ATTENTION

Please note that the UGA Behavior Medicine Service will be closed Friday, May 19th, 2023 through Friday, June 9th, 2023. We will be back in the office Monday, June 12th, 2023. Any emails sent after 2pm on Thursday, May 18th will be answered by Thursday, June 15th. If you have any questions, please reach out to our client care team at (706) 542-1984. For treatment questions or concerns, please contact your primary care vet. If this is an emergency, please see a local ER clinic or the UGA ER at 2200 College Station Road (706-542-3221.) Thank you for your patience and understanding!

Prescription refill requests must be submitted before 12pm on Tuesday May 16 for ample processing time prior to our closure. Any requests received after that time cannot be guaranteed.

"*" indicates required fields

PLEASE NOTE: This recheck form must be submitted prior to being scheduled for your appointment. Please fill in all fields and hit "Submit" at the end. After the form is completed, a member of client services will reach out to you to schedule on our first available business day. If you need prescription refills prior to your appointment, email the service at behavior@uga.edu with all medication information (names, doses, and frequency of administration).

Thank you and we look forward to seeing you and your pet(s) again!

Date and time of appointment

Client Name*

Patient Name*

Species and Breed (if purebred)

Age/Date of birth

Sex

Neutered/Spayed? At what age?

Weight (last known, in kg)

For cats only: declawed?

1. What is the primary problem for which you are returning to us? Did it change it severity, duration, frequency and time of recovery? If yes, how?

Please describe the last incident of the problem behavior and any other incidents that you consider important.

2. Please list all medications, doses, frequency of administration, their response, and any side effects.

3. In what areas has your pet improved?

4. Has your pet developed any new behavior issues?

5. Describe the management and behavior therapy exercises you have been implementing at home and how you feel your pet is responding to them. Were any parts of the treatment plan difficult or confusing?

6. Have there been any changes in the household or routine since your last appointment? If your pet used to respond differently to one family member than other, has this changed since your last visit? Please describe.

7. Have there been any changes in your pet's medical history since your last appointment?

If yes, please ask your vet to send all pertinent records to cpcvth@uga.edu or 706-608-8369.

Yes

No

8. Would you like to purchase medications during the appointment or would you like prescriptions to take to your local pharmacy?

Medications from UGA

Prescriptions to external pharmacy

9. What are your goals for this recheck appointment? Any additional comments?

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Athens, GA 30602