Pre-visit: Sick Patient

Pre-Visit Sick Pet Assessment

We are honored that you have chosen us to provide the care that your pet needs. Prior to your pet's appointment we ask that you take the time to provide your contact information and answer the following questions regarding your pet's medical history and current lifestyle.
Are you a new or existing client?*

New clientExisting client with a new petExisting client with an existing pet

Sorry for the inconvenience!

We ask that you complete this form instead.

Has any of your personal information changed or need updated since your last visit?*

YesNo
Have you or anyone in your household been exposed to or diagnosed with COVID-19?*

Consent to Release Information
I give consent for All Pets Health Center to release/receive information for all of my pets to the following:

Boarding/Grooming FacilitiesAny Veterinary Clinics and/or HospitalsBreeders and/or Rescue organizationsPet Insurance companiesNone of the above.
I grant permission to All Pets Health Center to use images or videos taken of myself and/or my pet(s) for use in digital or printed materials for any lawful purposes that may include advertising, display distribution, marketing materials, website content, and social media.

YesNo
I authorize the following individuals, not already listed on my account, to act as an agent for my pet's medical care in the event that I am not present.
By signing below, I certify that I am above the age of eighteen and am the person listed above.
Signature

Clear
Should be Empty:

Pre-Visit Sick Pet Assessment