CLIENT CURBSIDE DROP OFF FORM

CLIENT CONTACT (PHONE NUMBER WHERE YOU CAN REACHED TODAY)

NAME OF OWNER:

NAME OF PET BEING SEEN TODAY:

EMAIL ADDRESS:

example@example.com

HAVE YOU DOWNLOADED OUR MONTICELLO AH APP?

WHAT IS THE AGE AND THE SEX OF THE PET?

IF OTHER PLEASE LIST:

IS THE PET ON YEAR ROUND FLEA/TICK/HEARTWORM PREVENTION?

HAS THE PET BEEN BOARDED OR IN CLOSE CONTACT WITH OTHER PETS

CURRENT MEDICATIONS:

CURRENT DIET:

WHAT ARE WE SEEING YOUR PET FOR TODAY?

WHEN DID THE PROBLEM BEGIN?

IS THE PROBLEM BETTER, STAYED THE SAME, OR BECOME WORSE?

HAVE YOU TREATED THE PET WITH ANY MEDICATIONS OR HOME REMEDIES?

ANY ADDITIONAL INFORMATION YOU WOULD LIKE THE DOCTOR TO KNOW?

PICK UP INSTRUCTIONS:

We thank you for entrusting your pets' health with our staff. We want to help ease your fears and make your pets stay comfortable. Dr. Wallis or Dr. Pickett will call with an update on physical exam findings as well as any recommendations and or treatments your pet may need. The doctor will give you a curbside pickup time. Call us at 913-422-0301 when you are out front and a MAH staff member will deliver your pet safely to your vehicle. Thanks for your flexibility, we appreciate your willingness to work with us during the covid 19 crisis.

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