Pre-Visit Form

Appointment Date *

Appointment Time *

What kind of appointment would you like during your visit? *

Curbside
In Person

I will be in this vehicle: *

(please list model & color)

Best Phone number for today's appointment: *

(the veterinarian and medical team will use this number to communicate with you throughout the appointment)

I understand that I need to call or text the hospital when I arrive for my appointment and a medical team member will come to escort my pet into the hospital for their exam while I wait in my car. *

I understand and agree.

I understand that all cats must be brought in secure carriers and all dogs must be on leashes. Collars and harnesses must fit properly and snugly to prevent your pet from escaping on their way into the hospital. *

I understand and agree.

I understand that I must wait in the parking lot and be readily available for the veterinarian to call to discuss my pet's care. I will not leave the parking lot during my pet's appointment unless I explicitly discuss it with the medical team and complete the required admission consent form. *

I understand and agree.

I understand that I need to call or text the hospital when I arrive for my appointment and a medical team member will review my pet's history with me over the phone prior to escorting me into the hospital. *

I understand and agree.

I understand that I am required to wear a well fitted mask (fully covering both mouth & nose) prior to entering the hospital and keep it on for the entire duration of my time in the building. This requirement is for all individuals entering our building, regardless of vaccination status, and those who are unable or refuse to wear a mask will have a curbside appointment. *

I understand and agree.

I understand that only ONE client will be permitted to escort my pet into the hospital. Mothers with a young infant or toddler will be permitted, but clients who arrive with numerous older children will have a curbside appointment. *

I understand and agree.

I understand that all cats must be brought in secure carriers and all dogs must be on leashes. Collars and harnesses must fit properly and snugly to prevent your pet from escaping on their way into the hospital. *

I understand and agree.

I understand that I should not enter the hospital if I have had known exposure, been diagnosed with or had symptoms of COVID within the last 7 days. If I have, I will contact the hospital to determine the safest way for my pet to receive care. *

I understand and agree.

Email *

Client's Name *

First

Last

Patient Name *

Patient Species *

Canine
Feline

Primary Reason for Appointment / Concern (please be as detailed as possible in your concerns) *

List all medications, parasite prevention and/or supplements your pet is currently taking (please include amount/dose and frequency) *

Does your pet receive any pre-visit medications to alleviate fear, anxiety or stress? (trazodone, gabapentin, clonidine, etc) *

Yes
No

Does your pet need a refill of this medication prior to this visit? *

Yes
No

To minimize your pet's stress and set them up for success in the hospital, please verify that you have enough medication on hand for the visit and to follow the dosing instructions. If you have any questions or need a refill, please let us know at least 72hrs prior to your visit to give us ample time to respond and provide refills. If your pet does not receive their pre-visit medications, please be aware that sedation could be necessary or they may need to return at a later date.

Please submit a refill request HERE and note that it is for a scheduled appointment. If your pet does not receive their pre-visit medication(s), please be aware that sedation and/or rescheduling may become necessary to minimize your pet's stress and set them up for success during their visit.

Do you need any refills today? *

Yes
No

If you need a medication refill, please list which medications

Current Diet (please include brand, amount and frequency of meals) *

Patient's Appetite *

No change
Increased
Decreased

Patient's Thirst *

No change
Increased
Decreased

Patient's Energy Level *

No change
Increased
Decreased

Has your pet been experiencing:

Vomiting
Diarrhea
Coughing
Sneezing

Would you like to be provided an estimate of expected costs during your visit? *

Yes, please provide a detailed treatment plan and estimate prior to completing any services beyond my pet's exam.
No

Did you know that 1 in 3 animals will become lost during their lifetime? Only 21.9% of dogs are ever reunited with their owners and this number drops to less than 2% for cats! Microchipped pets are over 30% more likely to make it back home, and even more than that if their microchip registration is up to date. *

Please scan my pet today to check for a microchip
Please implant a microchip in my pet today ($54 including registration)
My pet has a microchip, please scan the number and ensure it is included in their file
My pet has a microchip but I am unsure if the registration is correct/current
My pet does not have a microchip and I do not want one. I understand the chances of my pet being reunited with me are incredibly slim should they ever become lost.

I understand that payment is due at time of service and come to your car to collect payment with a mobile card reader. We accept credit/debit cards, CareCredit, and cash only - NO CHECKS! *

I understand and agree.

I understand that I should NOT enter the hospital until I am escorted by a team member, regardless of what kind of appointment I have chosen above. I will call or text the hospital when I have arrived and await instructions on when it is safe to enter. This is done to minimize unnecessary interactions between clients in the lobby as well as to avoid the risks of potentially reactive/combative pets interacting with each other. *

I understand and agree.

Signature *

Date *

This form is to help us expedite your appointment while ensuring we get all the necessary information about your pet into their record. Please fill it out to the best of your ability – the more detail you provide, the better care we can offer your pet during their visit!

Please ONLY fill out this form once you have spoken with our staff and scheduled an appointment. If you need to book an appointment, please contact the hospital before completing this form.

Pre-Visit Form

This form is to help us expedite your appointment while ensuring we get all the necessary information about your pet into their record. Please fill it out to the best of your ability – the more detail you provide, the better care we can offer your pet during their visit!

***Please ONLY fill out this form once you have spoken with our staff and scheduled an appointment. If you need to book an appointment, please contact the hospital before completing this form.***

Please ONLY fill out this form once you have spoken with our staff and scheduled an appointment. If you need to book an appointment, please contact the hospital before completing this form.