{"id":300,"date":"2022-03-16T18:33:00","date_gmt":"2022-03-16T18:33:00","guid":{"rendered":"http:\/\/libertyvillageanimalhospital.com\/blog\/?page_id=300"},"modified":"2024-06-07T17:15:48","modified_gmt":"2024-06-07T17:15:48","slug":"sick-pet-form","status":"publish","type":"page","link":"https:\/\/libertyvillageanimalhospital.com\/blog\/sick-pet-form\/","title":{"rendered":"Sick Pet Form"},"content":{"rendered":"<p><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-1728\"><form id=\"wpforms-form-1728\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1728\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/blog\/wp-json\/wp\/v2\/pages\/300\" data-token=\"87f76959d1dcd58991f4ea40927977e2\" data-token-time=\"1776311952\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1728-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1728-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-1728-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1728-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-1728-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1728-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1728-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1728-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_3\">Phone Number<\/label><input type=\"number\" id=\"wpforms-1728-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" step=\"any\" ><\/div><div id=\"wpforms-1728-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_4\">When did your pet start to feel unwell? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1728-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-1728-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_5\">Has your pet\u2019s appetite been affected? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1728-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-1728-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_6\">How are your pet\u2019s energy levels currently? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1728-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-1728-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_7\">What changes are there to your pet\u2019s demeanour?<\/label><input type=\"text\" id=\"wpforms-1728-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-1728-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_8\">Has there been any coughing? <\/label><input type=\"text\" id=\"wpforms-1728-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" ><\/div><div id=\"wpforms-1728-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_9\">If so, is it a dry or wet cough? Is your pet bringing anything up when they cough?<\/label><input type=\"text\" id=\"wpforms-1728-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" ><\/div><div id=\"wpforms-1728-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_10\">Has there been any sneezing? If so, is it productive?<\/label><input type=\"text\" id=\"wpforms-1728-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-1728-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_11\">Is your pet vomiting at all? If so, what is your pet bringing up?<\/label><input type=\"text\" id=\"wpforms-1728-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-1728-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_13\">Has your pet experienced any change in their water consumption?<\/label><input type=\"text\" id=\"wpforms-1728-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-1728-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_14\">Has your pet experienced any change to their urination?<\/label><input type=\"text\" id=\"wpforms-1728-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" ><\/div><div id=\"wpforms-1728-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_15\">Has your pet had any recent travel (Local or Internationally)?<\/label><input type=\"text\" id=\"wpforms-1728-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/div><div id=\"wpforms-1728-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_16\">Is your pet on flea\/tick\/heartworm prevention? <\/label><input type=\"text\" id=\"wpforms-1728-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" ><\/div><div id=\"wpforms-1728-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_17\">What is your pet\u2019s current diet?<\/label><input type=\"text\" id=\"wpforms-1728-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" ><\/div><div id=\"wpforms-1728-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_18\">Is your pet on any medications? <\/label><input type=\"text\" id=\"wpforms-1728-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-1728-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_19\">Has your pet experienced any similar symptoms in the past?<\/label><input type=\"text\" id=\"wpforms-1728-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-1728-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1728-field_12\">Has your pet had any abnormal stool? If so, please reference the below image to tell us what your pet&#039;s stool resembles this:<\/label><input type=\"text\" id=\"wpforms-1728-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1728\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/pages\/300\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1728\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><br \/>\n<img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/libertyvillageanimalhospital.com\/blog\/wp-content\/uploads\/2022\/04\/Screen-Shot-2022-03-22-at-3.40.02-PM-255x300.png\" alt=\"Fecal Score Chart\" width=\"255\" height=\"300\" class=\"alignnone size-medium wp-image-303\" srcset=\"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-content\/uploads\/2022\/04\/Screen-Shot-2022-03-22-at-3.40.02-PM-255x300.png 255w, https:\/\/libertyvillageanimalhospital.com\/blog\/wp-content\/uploads\/2022\/04\/Screen-Shot-2022-03-22-at-3.40.02-PM.png 528w\" sizes=\"(max-width: 255px) 100vw, 255px\" \/><\/p>\n<p>Please give us a call if you have any questions or concerns regarding this appointment. Thank you so much for your time. This document provides information for doctors and medical team to start the Patient&#8217;s examination and prepare a plan to discuss with you during the consultation.<br \/>\nThe Staff of Liberty Village Animal Hospital<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Please give us a call if you have any questions or concerns regarding this appointment. Thank you so much for your time. This document provides information for doctors and medical team to start the Patient&#8217;s examination and prepare a plan to discuss with you during the consultation. The Staff of Liberty Village Animal Hospital<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/pages\/300"}],"collection":[{"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/comments?post=300"}],"version-history":[{"count":1,"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/pages\/300\/revisions"}],"predecessor-version":[{"id":1732,"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/pages\/300\/revisions\/1732"}],"wp:attachment":[{"href":"https:\/\/libertyvillageanimalhospital.com\/blog\/wp-json\/wp\/v2\/media?parent=300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}