Curbside Appointment Check-In
Pet's Name
*
Name
*
First Name
Last Name
Parking Spot / Car Description
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
Other
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
Other
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
Other
While my pet is here I approve any of the following recommendations that may be suggested by the veterinarian to treat/diagnose my pet. (Select all that apply)
X-rays
Ear Cytology
Ear Cleaning / Flush
Fine Needle Aspiration
Subcutaneous Fluids
Urinalysis / Cysto(urine collection)
Skin Cytology / Scrapping
Recommended Bloodwork
Anal Gland Expression
Nail Trim
Anything Necessary
Nothing - Call 1st to discuss (understand it may slow down the process)
Other
Is there anything we should keep in mind when working with your pet? Ex. Doesn't like men, deaf, blind, dog aggressive...
Please answer all of the following questions.
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
Submit
Should be Empty: