Risk Assessment Form in Farmington Hills Risk Assessment Owner's Name * Owner's Name First First Last Last Pet's Name * Dog or Cat * Dog Cat Date * Email * Does your pet have an opportunity to drink outdoor water or swim in lakes or ponds? * Yes No See # 1, 2, 3, 5, 7, and 8 Will you travel with your pet? * Yes No Where do you go? See #'s 1, 2, 3, 4, 5, 9, and 10 Do/Will you ever take your pet to a groomer, boarding facility, dog park, dog show, obedience class, day care? * Yes No See #'s 1, 2, 3, 4, and 8 Do/Will you foster, rescue, or volunteer at a shelter? * Yes No See all below Do you live or walk in wooded areas or hunt with your dog? * Yes No See #'s 1, 2, 3, 5, 7, and 8 Cats - Is your cat an Indoor cat? Yes No Is your cat an Outdoor cat? Yes No If your cat is an indoor cat only, see #'s 3 and 11 If your cat is both an outdoor and indoor cat, see #'s 3, 8, 11, and 12 Is your dog on monthly heartworm prevention? Yes No If yes, what product? Is your pet on monthly flea / tick prevention? Yes No If yes, what product? Comments Vaccine information: DHPP – D=Distemper, H=Hepatitis, P=Parainfluenza, P=Parvo virus. L or Lepto – Leptospirosis – Bacteria found in standing water, Carriers are rabbits, deer, wildlife. Transmittable to people. Rabies – Found in wildlife, required by State and Local ordinance. Bordetella (Kennel Cough) – Airborne – Grooming, boarding, daycare dog parks, etc. Give every 6 months Lyme – Tick borne disease Corona – Spread by virus shedding in the feces of an infected dog. Heartworm check – Blood draw – Transmitted through mosquitos. Fecal check – Tests for intestinal parasites. Recommended every 6 months. Some parasites can be transmitted to people. K9 Influenza N8 (Southern strain) – Florida – Airborne K9 Influenza N2 (Asian) – Chicago – Airborne FDVRCP – Feline Rhinotrachetitis – Calici – Panleukopenia – Chlamydia Psittaci Vaccine FELV – Feline Leukemia Virus – Transmitted through bodily fluids. Captcha Submit If you are human, leave this field blank.
