Name: Paws & Claws Animal Hospital
Address: 5333 Oleander Drive, Wilmington, NC, 28403
Telephone: (910) 399-3768

Client Name:

Pet Name:

Email:

Phone:

Date

Time:

When did symptoms start?

Was the sample refrigerated prior to drop off?

Urination frequency (to go out):

Less Frequent

Normal

More Frequent

Urine volume (per attempt):

Small Volume

Normal Volume

Large Volume

Is the patient straining to urinate?

Urine Color:

Accidents in the home?

Drinking habits:

Eating Habits:

Note any medications, supplements, or recent diet changes:

Would you like your container back?