Mass History Form

Pet's name: *

Are there signs of illness? *

Yes

No

Did the patient suffer any trauma in the area of the mass? *

Yes

No

Not sure

Is the patient up to date on vaccines? *

Yes

No

Not sure

Where on the body were the vaccines given? *

Do you already have an appointment scheduled? *

Yes

No

How long has this mass been present? *

Has it increased in size? *

Yes

No

Not sure

If yes, what is the time and date?

Name: *

Does the mass bother the patient? *

Yes

No

Not sure

Phone: *

Have there been any changes in the patient's behavior? *

Yes

No

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