Veterinary Appointment Check-In Form

Thank you for considering Kachemak Bay Animal Hospital for your pet's needs. Please fill out our Check-In form below to ensure we can provide you and your pet with the best possible care.

This form is for existing clients who have an upcoming appointment. If you need an appointment, please call or text our office number at 907-235-0143.

Have you ever brought a pet to Kachemak Bay Animal Hospital before?*

YesNo, please follow the link below to complete the new client registration form:

New Client Registration Form

Name*

First NameLast Name

Phone Number*

Please enter a number where you can be reached.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you have moved within the last year, or if your phone number or primary email address has changed, let us know so we can update your records. If nothing has changed, please write N/A.*

Pet's Name*

Species

Gender

If your pet has been seen at a different clinic, write clinic name and location so we can request records be sent prior to your appointment. If not, write N/A*

Upload any related documents here (previous records, pictures, etc.)

Is your pet currently taking any medications? Do you need any refills?

Are you here for a health certificate appointment/consultation?*

YesNo

Health Certificate/Consultation

Please follow this link below to also complete the pet travel form at least 2 days prior to your appointment. The information you provide will allow us to start the process of a Certified Veterinary Inspection (CVI) for traveling with your pet. Please note that most Health Certificates are valid for 10-30 days, depending on how and where you are traveling. There are many steps involved for completion, please visit the USDA Pet Travel website and enter your destination to see the most current requirements.

PET TRAVEL FORM

Do you have medical concerns you want to discuss concerning your pet?*

YesNo

Are you here for a technician appointment (vaccine boosters, nail trims, anal gland expression, etc.)?*

YesNo

Please be aware that technician appointments for vaccine administration, with the exception of Rabies, is provided by a veterinary technician/assistant who is legally not qualified to diagnose and discuss illnesses. If you have scheduled a technician appointment and your pet requires doctor attention or you have medical concerns, you will need to reschedule with a veterinarian.

I have read the above statement and understand the limitations of a technician appointment.*

I Agree

Please read the following items and describe if your pet is experiencing the following symptoms:

	Yes	No	Remarks / Notes
Coughing
Sneezing
Nasal discharge
Eye discharge
Ear discharge
Vomiting
Diarrhea
Not normal stool
Not normal urine
Change of Appetite
Lethargic (weakness)
Limping
In pain
Lumps or bumps
Teeth/mouth problems

Additional concerns we should be aware of:

Kachemak Bay Animal Hospital uses email and/or text for communications regarding our patient's reminders for health care needs. We do not provide reminders for appointments or services due by mail. If you choose not to be contacted by email and/or text, we cannot guarantee timely reminders regarding your pet(s) health. Do we have your permission to contact you via email and/or text regarding these reminders?*

YesNo

By signing below, I declare I am over 18 years of age, the lawful owner of the pet and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Kachemak Bay Animal Hospital to examine and treat my pet(s). I assume responsibility for all charges incurred in the care of this animal.*

Date Signed*

Date

Veterinary Appointment Check-In Form

Owner Information

Pet Information

Consent