Client and Patient Forms

If you need to fill out one of our forms prior to your consultation, see below to complete whatever you need for your pet at your convenience. Please let us know if you have any questions!

Call Now (757) 935-9111

Client/Patient Form

Client or Patient Form

Client Information

Pet Owner's Name

First

Last

Address

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Work Phone

Employer's Name

Client Date of Birth

Second Authorized Contact

First

Last

Relationship

Phone

*Patient information will be released to second authorized contact.

Veterinarian Information

Primary Care Hospital/Veterinarian

Secondary Specialty Hospital/Clinic (If Applicable)

If you are human, leave this field blank.

Cardiology Respiratory Rate Sheet

Monitoring Respiratory Rate at Home

1. Choose a time when your pet is sleeping.
2. Count respirations for 15 seconds. Each respiration is the movement of the chest out and in again.
3. Multiply your count during the 15-second interval by 4 to obtain the respiratory rate per minute or breaths per minute (bpm).

A normal respiratory rate is generally less than 30 or 40 breaths per minute. There is no lower limit and rates lower than 15 bpm may be recorded, especially during sleep. If your pet’s respiratory rate increases by 15-20% from one day to the next, CALL Dr. Small (757-935-9111) or if after hours, contact your nearest veterinary emergency clinic for advice.

**There are 2 free downloadable apps on your smart phone to help guide you while taking your pets resting respiratory rate:

i-phone- Cardalis, *BIVI;
Droid- *BIVI (*resting respiration rate/@yourdogsheart.com)

Date

Resp Rate (bpm)

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