Urine Sample - Dog Form | Town and Country Veterinary Services

Owner First Name:

Owner Last Name:

Pet Name:THIS FORM WILL NOT BE PROCESSED WITHOUT NAME INFORMATION FILLED OUT!

USE OF THIS FORM IS INTENDED FOR PATIENTS WITH APPOINTMENTS ALREADY SCHEDULED AT THE CLINIC OR FOR PETS NEEDING FOLLOW UP LAB WORK.

Need tips for collecting Urine from your Dog? Urine Luck!!

If your dog has a favorite time or spot for urination- this is a good spot to start trying.
Keep him/her on a short leash so they remain close to you.
Use a low flat container or a ladle to slide under them as they begin to urinate.
Place sample in a container with a lid
If unable to get to the clinic right away then place the sample in the refrigerator. Be sure to get it to the clinic within 12-16 hours of collection of the sample.

Please answer the following questions:

Email Address *

Why are you bringing in a urine sample today?

When did you first notice these signs/symptoms?

Have you noticed your Dog straining to Urinate?YesNo

Have you seen blood in his/her urine?YesNo

Is he/she defecating normally?YesNo

Is he/she drinking more or less than normal?MoreLessSame

How often does he/she urinate in a day?

Is your pet having accidents in the house?YesNo

If yes, where?

Is your pet leaking urine when awake or asleep?YesNo

Is your pet urinating more or less frequently?MoreLessSame

Have you recently moved?YesNo

Does your pet signal less often to go outside?YesNo

Any new stresses in your life (new baby, new job schedule, new pet, etc.)?

Is your pet displaying other symptoms?

What brand of dog food do you feed your dog?

Has there been a change in food recently?YesNo

Any other questions or concerns?

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Urine Sample – Dog Form

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