Patient Information

Yes, I have an appointment scheduledNo, I will call Elkridge Animal Hospital at my earliest convenience to scheduleNo, I would like a staff member contact me

An Elkridge Animal Hospital staff member will contact you within 2 business days to schedule your appointment.

Our business hours are Monday-Friday 8AM to 7PM and Saturday 8AM to 3PM.

If your pet needs to be seen urgently, please contact our office at 410-379-6789 or a local emergency clinic.

Patient’s Name*

Owner’s Name*

First, Last

DogCat

Breed*

Color/ Markings*

Date of Birth/ Age*

Date or age

MaleFemaleUnknown

YesNoUnknown

Yes!No, but I would like more informationNo

Yes!No, but I would like a recommendationNo

YesNo

What conditions and/ or medications?

YesNo

Which medications and/ or food?

Yes, I can attach them now for reviewYes, I have a printed copyYes, I can provide the name and location of the previous veterinarian or hospitalNo

My pet has never been to a veterinarian before.My pet has not been seen by a veterinarian in many years.I just got my pet and did not receive any medical records.The medical records are lost and I do not know where they received treatment.Other

Please provide us with the name and location of your previous veterinarian or hospital, so we can request a transfer of records on your behalf. By providing my previous veterinarian's information, I authorize Elkridge Animal Hospital to request the records from them.

I would like to upload a copy now.I will email them to info@elkridgevet.com at my earliest convenience.I am unable to provide them now but will bring them to my appointment.

Medical Records

YesNo

I acknowledge that voice recordings are made during consultations and related interactions which are utilized solely for the purpose of creating and maintaining accurate medical records. These recordings are a part of our documentation process to ensure high-quality care and comprehensive clinical notes.*

Date*

Date