Wellness Exam Form
Best Contact Number (at time of visit)
Please enter a valid phone number.
What day and time is your appointment?
What is the main purpose of your visit?
Annual Fecal/Heartworm Test
General Wellness Exam
If your pet is a cat, do they go outside?
My pet is not a cat
What food does your pet currently eat (brand name, wet or dry, specific amount daily)?
Is this food grain-free?
How often do you feed your pet?
Three times Daily
Free Feed (food is left out at all times)
Is your pet current on preventatives? If so, what preventative do you use?
Not current on preventatives
Advantage II/Advantix/Advantage Mutli
Please list your pet's current prescription medications, if applicable.
Are there any additional services or products that you would like to request at this visit?
Nail Trim ($17)
Anal Gland Expression ($15.75)
Ear Cleaning ($18.50)
Need to Purchase Preventatives
Need to Purchase Food
Do you have any concerns regarding your pet's behavior or physical health that you would like to discuss with the doctor?
Lake Austin Blvd Animal Hospital (LABAH) will contact you if additional diagnostics (x-rays, blood work, etc.) are necessary. In the event we cannot get in contact with you, does LABAH have permission to run additional tests?
If yes, you approve additional testing up to a total bill of what amount?
If you have been to another veterinary hospital or vaccine clinic within the past 3 years, please provide their name and contact information so we may obtain records for your appointment.
Do you have any concerns you would like to discuss with the doctor today?
Please note, this is not a drop off appointment (unless otherwise specified by staff). Due to limited kennel space in our clinic, we ask that you please remain in your curbside check-in spot for the duration of your pet's appointment. If you leave without notice, a boarding fee of $28.00 will be added to your bill. By signing, you agree that all information is true and you understand the fee associated with leaving the property will be added to the final bill.
Should be Empty: