Maywood Patient History Form - Illness/Injury Visit

If you or a member of your household have traveled within the last 14 days and/or are ill with COVID-19 or ANY OTHER illness, please have a friend/relative bring your pet in or wait to make your appointment for when your quarantine is over and/or you are feeling better. Please contact us to reschedule if need be. *

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When interacting with staff employees it is required that you wear a mask properly covering your mouth and nose. We also request that you stay at a 6-foot distance when possible. *

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Upon arriving to your appointment, please text 201-646-5001 to let us know that you are here. Please allow us up to five minutes to confirm that we have received your text message. This is our preferred method of check-in. Please only call if you do not have access to text as we are experiencing high call volume during this time. *

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Following your pet's exam, we will e-mail you a secure link for payment. Once payment is received, the technician will escort your pet out to you. During this time, credit card payment is preferred. Please try to avoid cash or checks. *

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Unless you have a true pet emergency, please refrain from engaging with the staff members you see assisting others in our parking lot. Please also do not honk your car horn to get the attention of our staff as this can be very scary for our patients. We understand that it is much easier to talk with a person to check in or ask for help, but these individuals are already helping others. Please text our office and someone will be with you as soon as possible. *

I understand the above statement

How do you wish to participate in your pet's exam? *

Virtually via Google Meet Curbside

*If you prefer Google Meet, please download the app prior to appointment. After the technician takes your pet inside, you will be invited via text message to join a virtual meeting of your pet's exam. Please join as soon as you receive the link as we cannot postpone beginning the exam due to our tight schedule.

*If you prefer curbside, you will receive a call from the doctor after your pet's exam has been completed.

Please list the cell phone number that we should call and/or text on the day of your visit: *

Area Code Phone Number

Please sign your signature to acknowledge our COVID-19 Policies: *

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Patient History

Updates on COVID-19