Check In Form

This form helps our veterinary team provide the safest, most compassionate care possible. By Understanding your pet's past experiences, behaviors, and any medications used for veterinary visits, we can better prepare to make the appointment less stressful for your pet, for you, and for our staff.
Appointment Date and Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Owner's Name*

First NameLast Name
Name of person bringing in pet (if different from owner)

First NameLast Name
Is this person authorized to make medical decisions on the owner's behalf?

YesNo
Pet's Name*
Species*

CatDogOther
Breed (best guess)*
Reason for visit*
Is your pet on any medications or supplements? If yes, please list them.*
Have there been any recent behavior changes at home? (Appetite, frequency of urination, lethargy, anxiety, etc.)*
Has your pet ever shown signs of fear, aggression, or stress during a veterinary visit?*

YesNo
Please describe your pet's previous behaviors during veterinary visits.*
What specific behaviors have you noticed during veterinary visits? (check all that apply)*

Trembling or ShakingPanting ExcessivelyHiding or Avoiding HandlingGrowling or HissingLunging, Snapping, SwattingOther
Are there any procedures your pet has previously not liked having performed or that seemed difficult for you or the staff to do? (nail trims, temperature, ear exam, blood draw*
Has your pet ever been prescribed any supplements or medications to help with a vet visit?*
Has your pet ever bitten anyone?*

YesNo
Click either image below to learn about the benefits of muzzle training, or how to prepare your cat for a calm vet visit.
I confirm that, to the best of my knowledge, my pet does not pose an unreasonable safety risk to me, the veterinary team, or other clients and patients during this visit. I understand that if my pet shows behavior that threatens the safety of people or animals, the veterinary team may modify, stop, or postpone treatment for safety reasons.
Client Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: