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Existing Patient History Form

    Practice *

    Date of Appointment *

    Appetite *

    Thirst *

    Urination *

    Defecation *

    Vomiting *

    Coughing *

    Sneezing *

    Vision/Eyes *

    NormalAbnormal

    Hearing *

    NormalDecreased

    Skin/Coat *

    Ears *

    Activity *

    Pain *

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