General Sick Check-In Form

Sick Check-In Form

Please be prepared for this form to take about 5-10 minutes to fill out. If you are a new client, please have your pets medical records handy as there will be a section to upload them at the end of this form.
Client Name*

First NameLast Name
Pet Information
Name *
Age
Sex
Breed

What food are you feeding your pet currently and how often? *
Is your pet's appetite normal? *
How has your pets appetite changed? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Has your pet had any vomiting or diarrhea recently? *
How often is your pet experiencing vomiting or diarrhea? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Has your pet had any coughing or sneezing recently? *
How often is your pet experiencing coughing or sneezing? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Is your pet drinking and urinating normal? *
What has changed with their drinking and urination habits? Is this a new problem or ongoing? Is there anything else you want us to know about this problem?
Is your pet on any current medications besides heartworm, flea and tick prevention? *
What medications are they currently on? Please list the dosage they are getting and how often you are giving it.
Do you need any refills for any of these medications? If yes, please list which ones.
What are your main concerns for your pet's sick appointment today? How long have the symptoms beeing going on? Is this an ongoing problem? *

Is your pet on heartworm and/or flea/tick prevention? (ex: Heartgard, ProHeart, Trifexis, Simparica Trio)
What type of prevention are you giving currently?

Rabies Vaccine

If your pet is not up to date on Rabies vaccine it is up to the discretion of the veterinarian whether or not it may be required at the appointment. Rabies vaccine is required by law as it is a deadly zoonotic disease. We take all precautions to protect your pet and our staff.

If your pet is sick and vaccination is deemed not safe by the veterinarian on the day of the appointment, we will recommend return for the vaccine.

Last year, 2024, there were 6 confirmed Rabies cases in Polk County alone.
Is your pet up to date on their Rabies Vaccination? Please upload the proof of Rabies vaccine on the next page. If we do not have proof of the vaccine we will assume it is not up to date.

Please upload any records you have for your pet including vaccine reminders.

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Sick Check-In Form