SMR Owner History Survey URLThis field is for validation purposes and should be left unchanged.Dog's Name*Owner's Name (first/last)*Is your dog currently on the following preventative care?* Rabies vaccine Distemper vaccine Lyme vaccine 4DX (annual heartworm/tick test) Flea/tick prevention Heartworm prevention No preventative care What kind of flea/tick prevention do you use?* Isoxazolines (Simparica, Bravecto, Credelio, Nexgard) Topicals (K9 Advantix, Frontline, Vectra) Seresto collar Other type of collar Essential oil sprays None Other If you selected other, please include here:What is your dog's diet? Please list brand, type (kibble/canned/fresh), amount, frequency, and types/amounts of treats given.*Please list all medications, including the drug name, dose, and frequency of administration, that your pet takes:*Please list all supplements, including name, dose, and frequency of administration, that your pet takes:*Which of the following sporting/working activities does your dog participate in?* Agility Flyball Barn hunt Rally obedience Lure coursing/CAT Fast CAT Dock diving Freestyle Mondioring/French ring/Schutzhund Disc Earth dog Conformation Police apprehension work Detection work Search and rescue Herding Hunting Weight pull Field trial Canicross/mushing Retired None Other If you selected other, please include here:Please describe your dog's involvement in these activities (number of hours/days practicing and competing per week, etc.). If your dog is retired, please list the age at retirement and the length of his/her sporting/working career.*Does your dog go for regular walks? On or off leash? Approximately how long and how often?*Does your dog participate in regular off leash activity? Please describe.*If you have rested your dog, please describe the duration and degree of activity restriction (strict crate rest, discontinuing sport/walks, keeping off furniture, etc.).*What is your primary concern for today's visit?What are your goals for your sports medicine and rehabilitation appointment?* Δ