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  • Recheck Appointment Form

  • Client Information

  • Has the appointment location changed?*
  • Are there any changes to your contact information since the last appointment?*
  •  -
  • Are there any changes to your Primary Care Veterinarian since the last appointment?*
  •  -
  • Will you be attending the appointment?*
  •  -
  • Does the person attending appointment have the ability to authorize recommended diagnostics?*
  • If treatment is recommended, does this person have authorization to accept medication on your behalf?*
  • Is the person attending the appointment the same person who should be sent the pre-appointment preparation instructions?*
  • Format: (000) 000-0000.

  • Recheck

  • Have you completed any of the medication as prescribed?*
  • Please list medications and date completed*
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  • Is your horse still taking any of the prescribed medication?*
  • Please fill out medications still taking and the date started *
    Rows
  • Are there any prescribed treatments that have not been started?*
  • Please fill out medications not started*
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  • Are there any changes to the diet or supplements since the last appointment?*

  • If there have been any changes to your horse's diet and/or supplements, this is important information needed for your recheck examination

  • Is the horse currently in work?*

  • Payment

  • Would you like to pay with the credit card on file?*

  • Please contact the office with payment information prior to the appointment

  • Policy Acknowledgements
  • Should be Empty: