Blood Glucose Check Intake Form Owner*Date* Date Format: 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.Did your pet eat this morning?*YesNoIf so, what time?Current DietDid you give your pet insulin?*YesNoIf so, what time?How many units?Please comment on your pet's behavior at home in the last week, or since the last change in insulin dose:Energy LevelIncreasedDecreasedNo ChangeAppetiteIncreasedDecreasedNo ChangeThirstIncreasedDecreasedNo ChangeUrinationIncreasedDecreasedNo ChangeDo you have any other concerns about your pet?Phone number where you can be reached today*Email* EmailThis field is for validation purposes and should be left unchanged.