Client's Name *

First

Last

Email *

Pet's Name *

Date *

Clients can choose to do curbside if they wish, Let us know when booking their appointment and call to let us know when they have arrived.

Who will be bringing your pet to the appointment? *

Me
Other

Please specify. Note that payment my card, the name of the person present for the appointment must be on the card.

Please answer the following questions

Species *

Dog
Cat

Is your pet eating & drinking ok? *

Yes
No

What kind of food are you feeding? *

How much? Example ( 1c per meal ) *

How often does your pet eat? *

1x Daily
2x Daily
3x Daily
Free Feeding

Is your pet currently taking any Medications or supplements? (including prevention)? *

Yes
No

Please list the names, dose and frequency: (copy)

Do you need any medication refills today? *

Yes
No

Please list medication refills:

Has your pet ever had an adverse reaction to a vaccine or medication? *

Yes
No

Does your pet come into contact with any other animals (such as family/friend pets)? *

Yes
No

Does your pet have insurance? If so, who is their provider? *

Do you have any specific questions for the doctor today?

Bloodwork

Would you like to perform annual bloodwork on your pet today?

Yes
No

Beginning at the age of 2 years, we recommend a yearly blood panel to get an idea of your pets metabolic and organ health.

Select blood work: *

I would like to run a basic internal organ screen (liver, kidneys) with full red and white blood cell count, and electrolytes.
I would like to discuss bloodwork screening options for my pet at this exam.
I decline bloodwork screening for my pet at this exam.

Thank you for your help in answering these important questions! As a reminder, payment is due when services are rendered. If you need an estimate for your appointment please call us and we can email you one.

Signature *

Clear Signature

Date *

Annual Exam Pre-Check-In Form

Annual Exam Pre-Check-In Form

Ready To Visit!

Questions?

Location

Contact Information

Hours