Canine- New Puppy/ Dog - First Visit
Client Name
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First Name
Last Name
Pet Name
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Phone Number for call or text during pet's visit
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Area Code
Phone Number
Appointment Day
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Month
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Day
Year
Date
Where did you get your pet?
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How long have you had pet?
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Previous Preventive Care (Vaccines, Deworming) - What and where?
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As much as you know or upload records below if you have them
Upload previous medical records here (or you can text us a picture of them if you are unable to do this) Please send them prior to the visit so we can be better prepared, if possible.
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Heartworm or Flea & Tick Preventive- What Product, Date last applied?
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Are you planning to have your pet spayed/neutered?
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yes
already done
no will breed
not planning to and not intending to breed
unsure
Any Behavioral or Medical Concerns?
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Anything else you would like us to know?
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How will you be paying today? (Cash, check, credit/debit, or care credit)
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In last 2 weeks, has pet had any potential exposure to person with symptoms of or that has been diagnosed with COVID-19?
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Yes
No
(Optional) Please upload a picture of your puppy for his or her file!
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