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Vet Care Form

Status(Required)

Fostering Only

Trial Adoption

Alumni

Name The Medical Issue(Required)

Urgency Of Issue(Required)

Low

Medium

High

DESCRIBE MEDICAL CONCERN

CDCK Dog Name (If this is for litter vaccine boosters, deworming, and spay/neuter choose Kitten or Puppy Wellness Visit and list the entire litter here)

Have you received the Box Link to the health records for your foster?(Required)

Yes

No

This Is For A Litter Of Puppies Or Kittens(Required)

Yes

No

Primary concern(s)*

Worms

Diarrhea

Loss of appetite

Lethargy (Only choose this option for critical cases. This is not for lower energy) - lack of response to surroundings; doesn't lift head; won't eat or drink

Dehydration

Vomiting

Pain or strain while urinating

Frequent ear scratching, swollen, irritated ears

Eye discharge

Coughing and colored nasal discharge

Dry Cough

Sneezing

Hair loss

Skin itchy/scratching

Ringworm (confirmed or suspect)

Spay/neuter incision

Other surgical incision

Lameness

Wound - tear, cut or puncture

Dental

Lumps

Kitten Litter due for vaccines, deworming, or spay/neuter

Puppy Litter due for vaccines, deworming, or spay/neuter

Other

Please Describe(Required)

ONLY ADD AN OTHER IF THE CONDITION DOES NOT FIT INTO ONE OF THE OPTIONS ABOVE

If your foster dog has worms, you can stop by the office to pick up dewormer. There is no need for a vet visit. You can check the office hours schedule on our website, http://www.citydogsrescuedc.org/contact-us.html. Alternatively, you can order dewormer from Amazon or pick up from a larger pet store in your area.

Explain Primary Health Concern(Required)

How long has it been since you first noticed this health concern?(Required)

What is the frequency, duration, and severity of this health concern?(Required)

What action has been taken so far? Have you seen any changes or improvements?(Required)

Have there been any recent changes in your foster's schedule, food, etc?(Required)

Other than your current concern, how is your foster's overall health?

VIDEO

Did you email any videos/photos for our reference?

Yes

No

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