Blood Glucose Curve – Drop Off Form Patient Name*Date* Date Format: MM slash DD slash YYYY When did you last give your pet insulin?Date Date Format: MM slash DD slash YYYY Time : HH MM AMPM AmountHas your pet eaten today? If so, what time?What brand/type of food do you feed your pet?How much insulin do you administer per day and how often?At what time do you administer your pet's insulin?What type/brand of insulin does your pet receive?Is your pet eating / drinking normally? Please describe any changes in detailIs your pet urinating normally? Please describe any changes in detailHave you noticed any changes in your pet’s behavior? Please describe.Owner's Signature*Phone number where you can be reached today*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.