Blood Glucose Check Intake Form"*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.Owner*Date* MM slash DD slash YYYY Pet*Chart #* Diabetic patients require frequent monitoring of blood glucose to make sure we are dosing insulin appropriately. In newly diagnosed patients, we generally start with quick "spot checks" to get a ballpark estimate of a pet's blood glucose. In order to get the most accurate data for long-term treatment, a blood glucose curve is recommended. For a curve, your pet will be here all day for blood sampling every 1-2 hours to monitor response to insulin.1) What is your pet’s current diet and when was their last meal eaten?Current DietDay/Time2) If on insulin what type, what is the current dose and when was it last given?Insulin TypeCurrent DoseDay/time 3) Please comment on your pet's behavior at home in the last week, or since the last change in insulin dose: Energy Level Increased Decreased No ChangeAppetite Increased Decreased No ChangeThirst Increased Decreased No ChangeUrination Increased Decreased No Change4) Do you have any other concerns about your pet?Phone number where you can be reached today*Email*