CMVC Check-in Form

Hello and welcome!

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PLEASE NOTE: Starting 4/18/2022, curbside is optional and you may accompany your pet into the building for your appointment.

You will still call to check in from your car, and we will let your know when we are ready for you and your pet to come in for your appointment.

Over the past two years, many veterinarians have noticed how much more happy and relaxed pets are when they haven't been with other pet "strangers" in the waiting room. In order to keep pets as happy and calm as possible, we will still do the check-in procedure over the phone, then have you go straight to the exam room when the doctor is ready.

We can't wait to see you!

If you have any questions about this form, call or text the clinic at 859-223-5215.
Name*

First Name Last Name
Pet's name *
Email*
example@example.com
What is the date of your appointment? (It's okay if you don't remember, just put as close as you can.) *

MonthDay Year
Date
Would you like your appointment to be curbside or In-clinic?*

Curbside (You will remain in the car during the appointment.)In-clinic (You will still call to check in from the car, but will come into the clinic with your pet for the appointment.)
Reason for visit (Check all that apply)*

Vaccines/Routine Health ExamRoutine/Recheck bloodworkMedical ProblemNail TrimOther
If we are seeing your pet for a medical problem, please describe. Use as much detail as you would like.
Which flea/heartworm medicine do you give your pet? Please check all that apply. If none check "None."*

HeartgardSentinelProheart (the six month injection)NexgardRevolutionFrontlineSenergySomething, but I can't remember the nameNone
List any other medications your pet is taking, including over-the-counter meds and supplements. If you're not at home and can't remember, that's okay. Just fill out the best you can. If none, please write "None." *
Refills: If you need any flea, heartworm, or other medication refills let us know and we will go ahead and get them ready for you. If you don't need any, write "None." *
May we call or text you if we have any questions after reading this form?*

Yes, I prefer textYes, I prefer a phone callYes, either text or phone call is fineNo, I will be unavailable
If yes, what number?
*****UPDATED 4/16/2022***** COVID Protocol. Starting April 18, 2022, curbside is optional and you can accompany your pet into the building if you prefer. Check all boxes and then sign in the question below*

Masks are required in the building at this time.If I am having symptoms of, have been exposed to, or am under quarantine for COVID I will call and inform Clays Mill Vet Clinic BEFORE I come for my appointment.
By signing this I confirm that I understand the COVID protocol*

Clear
For your appointment, pull into a parking spot and call to tell us that you are at the clinic at our regular number (859-223-5215) and tell us your parking spot number. If you have any questions or comments, please put them here.
As always, you are welcome to call or text the office at any time with questions.
We would love to have a favorite picture of your pet! Please upload a picture if you have time. It will upload easily right from your phone or computer and just takes a few seconds. Thank you!!

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Arrival Procedure

It's easy! Remember, even if you are doing an in-clinic appointment, you will still call to check in from your car.

Just call or text to let us know you are in the parking lot and we will check you in over the phone. You can text our regular clinic number 859-223-5215.

As soon as the doctor is ready, we will have you and your pet come on in.

If you decide to do a curbside appointment, you will wait in your car during your pet's appointment.

Please feel free to call or text any time while you are waiting if you need anything.
Should be Empty:

Hello and welcome!