Eldorado Animal Clinic Exam Check-In Form
Thank you for choosing us to care for your pet! Please complete the check-in form below for your confirmed appointment. If you need to request an appointment, please call us at (505) 466-0650 and we will be happy to serve you.
Pet Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pet Name
*
Appointment Date & Time:
*
-
Month
-
Day
Year
Hour Minutes
AM
PM
AM/PM Option
What services would you like performed during this appointment? Please select all that apply.
*
Vaccines
Heartworm Test
Prescription Refills
Heartworm & Flea Prevention Medication
Fecal Screen for Parasites
Microchip
Nail Trim
Anal Gland Expression
Other
Any special concerns today?
*
Any coughing or sneezing? If yes, please describe.
*
Vomiting or diarrhea? If yes, please describe.
*
Have you noticed any lumps or bumps? If yes, where are they located, how long have they been there and have they changed in size?
*
Any changes in how much your pet drinks or urinates? Any change in appetite?
*
What brand/brands of pet food does your pet eat, including treats?
*
Please list all medications and/or supplements:
*
Signature
*
Submit
Should be Empty: