Fragebogen Neupatient

Angaben zu Besitzer/in

Vorname Besitzers/in:

Nachname Besitzers/in:

Name Tier :

Angabe zum Geschlecht
weiblichmännlichkastriertintakt

Wann war die letzte Läufigkeit?

Angaben zur aktuellen Erkrankung:

Bitte schildern Sie uns stichpunktartig die aktuellen Probleme/Symptome Ihres Tieres

Beginn der Erkrankung: Wurde Ihr Tier vorbehandelt?

Wenn ja, wie?

Mit welchen Medikamenten wird ihr Tier aktuell behandelt? (seit wann und in welcher Dosierung?)

Angaben zur Vorerkrankungen

War Ihr Tier in den letzten 3 Monaten in tierärztlicher Behandlung?

Wenn ja, warum?

Hat ihr Tier weitere therapiebedürftigen oder chronischen Erkrankungen?

Wenn ja, welche und seit wann?

Erhält ihr Tier regelmäßig Medikamente?

Wenn ja, welche und in welcher Dosierung?

Allgemeine Fragen

Wann war die letzte Impfung?

Wann war die letzte Entwurmung?

Wann war die letzte Kotuntersuchung?

Bei Katzen: Ist Ihre Katze ein Freigänger?

War ihr Tier schon einmal im Ausland

Wenn ja, wo und in welchem Jahr?

Vielen Dank für Ihre Unterstützung!

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