Pre-Appointment Questionnaire

Pre-Appointment Questionnaire

*This form is for existing veterinary/doctor appointments only*
This form is for clients with an existing veterinary / doctor appointment. If you do not have an existing appointment with us, please call our hospital at 651-739-0117 to schedule an appointment for your pet. Please do not complete this form without an appointment in advance.

If your pet is scheduled to see a technician or visiting any other service, please do not fill out this form as this form pertains to veterinary visits only.

Thank you!
Pet Owner Information

*Required fields marked with asterisks*
Your Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Pet Information
Pet's Name*
What is the reason for your pet's upcoming appointment?
Is your pet taking any medications or supplements? If so, please type them here.
YesNo
Please explain the eye or ear concerns that you have.
YesNo
Please explain the respiratory concerns and symptoms you have noticed.
NormalIncreasedDecreased
YesNo
Please explain any digestive concerns that you may have. Try to include how often and how long symptoms have lasted.
NormalIncreasedDecreased
YesNo
Please explain any urinary concerns you have noticed at home.
YesNo
Please explain any of the mobility concerns that you may have such as weakness, limping, or exercise intolerance.
Describe any other pertinent concerns you may have for your pet so we can do our best to address them at your pet's visit.
Which monthly heartworm preventative are you using for your pet?
Please include the brand name of the product you are using (ie Sentinel)
Which monthly flea / tick preventative are your using for your pet?
Please include the brand name of the product you are using (ie Simparica Trio)
Would you like us to refill any medications or preventatives at your upcoming appointment?
*Please note quantity preferred
Please describe your pets current diet including; type of food (dry, wet, combo), brand name, quantity of food per feeding and meals per day.
If you have any pertinent documents or records you would like us to have, please upload them here!

Browse Files
Records, pictures, videos can be included here. Cancelof
Every dog MUST be on a leash (please no flexi-leads) and every cat must be in its OWN carrier in order to enter our hospital. This is the for safety of your pet(s) and our team members.

Thank you for understanding.
Please type your name to sign here. Thanks!
Should be Empty:

Pre-Appointment Questionnaire

Pet Owner Information

Pet Information