Pediatric Visit - History and Intake

PEDIATRIC EVALUATION - Virtual Check-In

Our Preventative Healthcare plans allow our attending veterinarians to offer a reward program for preventative screening. Your veterinarian will evaluate your pet’s condition, breed, age, medical history and lifestyle to create a Health Risk Assessment (HRA)— identifying your our pet’s risk for potential disease. During this evaluation and family discussion we'll create actionable items which vaccinate your pet against infectious disease and allow us to manage other non-infectious diseases or conditions should they occur.
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
This Patient
Past Pertinent History or Current Concerns
Any prior boosters, medical conditions or care, de-worming? Please list dates here and upload any documents in the next field
You may upload any history documents here--or just feel free to bring them along

Browse Files
Documents for patients with a more involved or complex medical history should be brought along for scanning. Cancelof
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 specific questions you have about the appointment.
New, Most Pressing Concerns?
Are there any pressing medical or training questions or concerns since your pet's initial visit?

PEDIATRIC EVALUATION - Virtual Check-In

GENERAL INFORMATION

Resources

Health Conditions and Health History

Pain & Mobility Screen

Patient Behavior & Finish