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(417) 766-0486
mcclurevet@gmail.com
5261 N 22nd St, Ozark, MO 65721

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🕊️ Hospice Patient Information Form

Thank you for taking the time to share your pet’s health history. This information helps our team at Greener Pastures Hospice Care provide the most compassionate comfort, support, and dignity during your pet’s end-of-life journey. Every detail you share helps us create a peaceful care plan tailored to your companion’s needs. 💚🐾

Hospice Patient Form - Greener Pastures

🕊️

Hospice Patient Form

We appreciate you taking the time to share your pet’s medical information. This helps us support comfort, dignity, and the most compassionate care possible.

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Pet's Name *

Your Name *

First

Last

Email *

Phone *

Please tell us about your pet’s diet. *

Please tell us about any treats, dental chews, and human food your pet receives *

If your pet’s appetite has changed or if his/her eating habits have changed, please describe here. *

Does your pet readily eat his/her food? If not, do you offer treats/human food to entice your pet to eat? Please describe here. *

Please list ALL medications your pet is on. *

Does your pet have difficulty chewing or swallowing? Please describe here. *

Has your pet had any weight fluctuations? *

Yes
No

Has it become a challenge to maintain your pet’s weight? *

Yes
No

Does your pet tolerate exercise and play like before? *

Yes
No

Does your pet seem to be slow or painful when rising? *

Yes
No

Does your pet seem more sensitive to your grooming or touching over the lower back/hips? *

Yes
No

Does your pet seem more sensitive to your grooming or touching over the lower back/hips? *

Yes
No

Does your pet wander aimlessly and/or seem disoriented? *

Yes
No

Does your pet seem increasingly anxious, fearful, or irritable? *

Yes
No

Has your pet exhibited any unusual vocalizations? *

Yes
No

Does your pet seem to act “old”? *

Yes
No

Does your pet seem to enjoy life as much as before? *

Yes
No

When was your pet’s last visit to a veterinarian? *

Does a difficulty

Has your pet had any diagnostic done in the last year? *

Yes
No

If yes, where was it done at?

Can we contact your pervious veterinary office for your pet’s history? *

Yes
No

If your pet has had any behavior changes since his/her last visit, please describe here.

If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.

*Please note: Individual medical decisions are made only during your appointment. If you grant permission, we will contact your previous veterinary provider for records.

5261 N 22nd St, Ozark, MO 65721
(417) 766-0486
mcclurevet@gmail.com

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