Creature Comforts Check In Forms

I am submitting the following form:

Appointment Date and Time

Client Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pet Name

Vaccines/Etc Due today: Leave blank if you are unsure.

Where did you adopt your puppy from?

Vaccines/Dewormer Due:

Where did you get your new kitten from, and how long have you had them?

How's all training going? (litterbox, etc)

Is your kitten going to be indoors, outside, or both?

Client's main concern

How long ago did the problem start?

Have you tried any home remedies for this problem?

Is your pet experiencing any of the following?

Has your pet experienced any of the following since their last visit?

Has your puppy been experiencing any of the following:

Has your kitten been experiencing any of the following:

Describe any issues in detail:

Current Diet/Treats/Other

What symptom(s) was your pet having?

Tech visit: Doctor is not present. Please list purpose of visit

(ie. laser, subQ fluids, nail trims, ear cleaning, etc)

Any other questions or concerns you would like addressed at visit?

IF we are running a blood test for thyroid today, what time was thyroid supplement given today?

Since your last appointment, has your pet's condition improved?

Do you have any remaining concerns?

What concerns do you still have?

Did you have any challenges administering the medication?

What difficulties did you experience when administering medications?

Do you have any medication still left over?

If the issue is resolved, did we need to update vaccines?

How's all potty training going (potty/crate/etc)?

Future plans for pet (boarding/grooming/dog parks/classes, etc)

Please list all medications your pet is taking that you do NOT purchase at Creature Comforts: (Include all SUPPLEMENTS too)

Please list any refills needed on the medications that you buy through Creature Comforts. If none are needed, please write, "No refills needed".

Preventatives - Dog Owners:

Other brand?

Preventatives - Cat Owners: Is your pet on any brand of parasite prevention?

Signature: I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges are due at the time of visit or release after treatment.