Owner Name

Email Address:

Pet Name

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:

Why were you bringing in a urine sample today?

When did you first notice these signs/symptoms?

Have you noticed your Dog straining to Urinate?

Yes

Have you seen blood in his/Her Urine?

Yes

Is he/she defecating normally?

Yes

Is he/she drinking more or less than normal?

Less

Same

How many pets do you have in your household? (cats, dogs, other)

How often does he/she urinate in a day?

Is your pet having accidents in the house

Yes

If yes, where?

Is your pet leaking urine when awake or asleep?

Yes

Is your pet urinating more or less frequently?

Less

Same

Have you recently moved?

Yes

Does your pet signal less often to go outside?

Yes

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?

Yes

Any other questions or concerns?

Urine Sample - Dog