Curbside Appointment Check-In

Curbside Appointment Check-In
Pet's Name *
Name *

First Name Last Name
Appointment Time (If Applicable)

: Hour Minutes AM/PM Option
Color, Make, and Model of the Vehicle *
(Example: Red Honda Civic)
Please select all that apply. *

I have been experiencing cold/flu symptoms. I have traveled out of the country in the last 30 days. I have been exposed to COVID-19 or someone with it. None of the above
Phone Number to be reached at for today's visit *

Area Code Phone Number
The reason for your visit: *

Vaccines / Annual Wellness Exam Exam Recheck Tech appointment Medication / Food Pick-up
Please answer the following if your pet is here for an appointment. Skip to next section if picking up medications or food.
Has your pet been eating and drinking like normal? (If no, please explain and state when you noticed a change)
Has your pet experienced any diarrhea or vomiting? (If yes, please explain and state when it began)
While my pet is here I would like the following done, if possible. (Select all that apply).

All vaccines that are due Only select ones, regardless of what is due Bloodwork that is due (ex, heartworm blood test, thyroid panel, glucose check, etc) Fecal Sample Nail Trim Anal Gland Expression
Is your pet currently on any medications, supplements, or flea/tick/ heartworm medications? If so, please list them. *
What is your pets current diet at home? *
Example: Hills Science Diet Dry
Is there anything we should keep in mind when working with your pet? (Ex. Doesn't like men, deaf, blind, dog aggressive...)
Does your pet need any medication refills? Example: Heartgard/Simparica/Rimadyl.
Please include how many months supple of each medication you would like.
Are there any other questions or concerns regarding your pet?
Are we able to e-mail you a copy of your invoice when your visit is complete?

Yes, I will enter my e-mail below No, I prefer a paper copy
Email
example@example.com
Please keep your phone available and remain in or around your car until further communication with us. If you do not hear back from us by text or phone call in the next 5 minutes regarding your check in, please call us at 760-471-4950.
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