Complete Exam History & Check-In (New Exam, Annual Visit)

COMPLETE OR ANNUAL HEALTH EVALUATION - Virtual Check-In

The following health history/risk assessment is a comprehensive look at your pets most recent health history at home. If we haven't collected this information on your pet in more than 18 months, or if this is the first time we are getting to know your pet, this form is for you and your pet family. It will take about 10-20 minutes to thoughtfully complete, and is best completed by your pet's primary caregiver. Completing this intake to the best of
Pet's Primary Adult Caregiver - Full Name

First NameLast Name
Pet's Other Adult Caregiver(s) if Any
Name(s)
Valid Caregiver E-mail
Pet Patient's Name
Appt Date If Known

MonthDayYear
Date
Ownership Status
Briefly describe the breeder, rescue or other circumstances under which this pet was obtained. Please estimate the length of of your ownership. If this patient was obtained outside of Evansville, Indiana, where did they live before? Has there been any interruption In ownership (extended stays elsewhere, or with other persons lasting more than a few weeks)? With new patients, or patients regaining a relationship with our clinic, this can be helpful when evaluating risk of certain infectious or non-infectious disease.
If different than the caregiver(s) listed above, who is the adult person presenting this pet patient to Highland during the appointment/check in time?

First NameLast Name
Goals for today's visit
List your understanding of the purpose of this appointment or visit, and/or any questions you have about the appointment.

COMPLETE OR ANNUAL HEALTH EVALUATION - Virtual Check-In

GENERAL INFORMATION

Resources

Health Conditions and Health History

Pain & Mobility Screen

Patient Behavior & Finish