Dallas Veterinary Clinic - Appointment Check-in Form

Thank you for submitting this check-in form prior to arrival to help us stay on time and maintain accurate records for your pet. If you do not yet have an appointment and you're new to our practice, please go here (New Client Form). If you do not yet have an appt and we've seen this pet before, Request an appointment here.

What appointment type would you prefer?* This field is required.

In Person

Curbside

Inpatient Care

One person may come directly into exam room, stay seated in designated place. I agree to wear a proper mask over my mouth and nose the entire time in the building. Scarves/Bandanas/Gaiters are not permitted. I promise not to argue with the DVC team or give opinions about mask wearing since I have the alternate option to stay outside during my pet's appointment or inpatient care drop off, and I understand that everyone must wear a mask regardless of vaccination status.* This field is required.

I agree

Covid Screening Questions* This field is required.

Have you been exposed to anyone who has tested positive for COVID-19 in the past 14 days?

Have you experienced any COVID-19 symptoms in the past 7 days?

Please remain in the parking lot for the duration of your pet's appointment. Please keep your phone charged and available so the Doctor or Technician can reach you to discuss your pet's appointment and any treatment plans/instructions.

I am in this vehicle* This field is required.

(please list model & color)

An inpatient care fee for a well visit is $20 and any stays over 2 hours will incur a $70 hospitalization fee. I agree to schedule a pick-up time (5 min). I am aware that DVC closes at 5:30pm on weekdays/12pm Saturdays. I agree that if I cannot schedule a time to pick up my pet BEFORE closing time, I will pay for overnight unsupervised boarding. I have read and agree to the policies & requirements in the "Pet Hotel & Spa/Daycare Consent form". I will complete & submit the form now or I have already submitted the Hotel/Spa consent form since April 2021. I understand my pet will not be taken into the clinic without this consent on file.* This field is required.

Initial

* This field is required.

Owner First Name

Owner Last Name

Best Phone number for today's appointment

Preferred Contact Method

Patient's Name

Patient's Species

Please list preferred/unavailable times to contact, and we'll do our best to work with your schedule. Please note: the DVM may not be available to discuss at pick-up time.* This field is required.

Appointment Date/Time* This field is required.Please note: we charge a $10 late fee for arrivals more than 10 min past appointment time and appointments are not guaranteed if you arrive late.

Date

Hour

Minutes

$75 for missed doctor appointments and $25 for missed technician appointments without 24 business hours notice.

Pre-payment of the exam/consult or tech visit fee may be required after no-shows/multiple reschedules, and a deposit is required to book a surgery, which is non-refundable without 3 business days notice.

Please Initial * I understand and agree to the late cancellation fee policy.

Primary Reason for Appointment / Concern (please be as detailed as possible)* This field is required.

As Fear Free Certified Professionals, we want to make your pet's veterinary experience as enjoyable and as stress-free as possible. As such, it’s important for us to understand what your pet might find upsetting. The information will help us to adjust our care to better serve and comfort your pet. Please answer the following questions to the best of your ability so we can take into consideration both your and your pet’s preferences.

Does your pet show any reluctance to getting in the carrier or car?* This field is required.

Yes

How and where does your pet travel in the car? (carrier, seatbelt, loose, etc)* This field is required.

During travel to the veterinary hospital, does your pet do any of the following* This field is required.

Eager & excited

Reluctant

Hide

Drool

Vomit

Urine/BM

Subdued

Bark/Meow

Whine

Pant

Tremble

Other

None

Does your pet prefer* This field is required.

Female veterinary professional

Male veterinary professional

It Doesn't Matter

Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.* This field is required.

Getting in their carrier or the car

Going into the exam room

Entering the veterinary hospital

Being put up on the table for examination

Other pets and /or people passing by while in reception/check-in

Having direct eye contact with the technician and/or veterinarian

Waiting with other people and animals in the waiting area

Loud voices during examination

Being approached by veterinary staff

Having a rectal temperature taken

Getting on the scale for a weight

The use of instruments such as the stethoscope or otoscope(to look in the ears)

Hearing the doorbell, overhead intercom. or phones ringing

Being taken out of the exam room for procedures

Sounds coming from the back areas of the practice

None

How would you describe your pet around other animals and people?* This field is required.

Does your pet have any sensitive areas that s/he does not like to have touched by you or others?* This field is required.

What are your pet's favorite treats? (Please bring some to your next visit to our hospital)* This field is required.

Does your pet like to play with toys? If so, what kinds?* This field is required.

Has your pet ever been prescribed any supplements or medications to help with anxiety or fear with Vet visit to the veterinary hospital? If so, what was it and what sort of results did you experience?* This field is required.

Patient's Energy Level* This field is required.

Normal

Increased

Decreased

What brands of Parasite Preventative do you use?* This field is required.

Heartworm Preventative

Flea & Tick Preventative

Do you need a refill?

Have you missed any heartworm doses?

Would you like your pet to receive Proheart 6 injection (heartworm protection which lasts 6 months) when the next administering is due?* This field is required.

Yes

If a heartworm test is due soon (we can take care of it today to save another trip), do you want us to do a full internal organ health screening ($149)?* This field is required.

Yes

Heartworm test is not due soon

heartworm test is not due but I DO want the internal organ screening

If any vaccines (except boosters that need to be spaced 3-4 wks apart) are coming up due in next 30 days, do you want us to go ahead and update those today if the doctor thinks it's okay to do so?* This field is required.

Yes

No vaccines coming up

List Medications your pet is currently taking* This field is required.

Do you need refills of any of these medications* This field is required.

Yes

Do you need refills on any prescription pet food?* This field is required.

Yes

Patient's Appetite* This field is required.

Normal

Increased

Decreased

What type/brand of food are you feeding your pet? * This field is required.

How long have you noticed this change? * This field is required.

Drinking/Water Intake* This field is required.

Normal

Increased

Decreased

Is the patient coughing?* This field is required.

Yes

If Yes, patient Coughing* This field is required.

If yes, for how long?