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 you are 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 Name Last Name
Phone Number *

Area Code Phone Number
For your upcoming appointment, would you prefer curbside care or in-person care? **In-person care only available when an exam room is available**

Curbside In-Person
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.
Do you have any eye or ear concerns for your pet? *

Yes No
Please explain the eye or ear concerns that you have.
Do you have any coughing, sneezing, or respiratory concerns for your pet? *

Yes No
Please explain the respiratory concerns and symptoms you have noticed.
Is your pet's appetite... *

Normal Increased Decreased
Do you have any vomiting, diarrhea or stool concern for our pet? *

Yes No
Please explain any digestive concerns that you may have. Try to include how often and how long symptoms have lasted.
Is your pet's water consumption... *

Normal Increased Decreased
Do you have urinary concerns for your pet? *

Yes No
Please explain any urinary concerns you have noticed at home.
Do you have any mobility concerns for your pet? *

Yes No
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 Bravecto)
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. Cancel of
Hudson Road Animal Hospital is following CDC, MVMA and AAHA recommended guidance pertaining to sanitation and mask use within our hospital. Our team will be sanitizing all examination rooms after every use. Wearing a well-fitted mask is recommended but not required in our hospital.

Pets must be on a leash (please no flexi-leads) or in a carrier in order to enter our hospital.
Please type your name to sign here. Thanks!
Should be Empty:

Pre-Appointment Questionnaire

Pet Owner Information

Pet Information