hoofandpawvet.com - Wellness Vacation Check-In Sheet Online

Wellness/Vaccination Check-In Sheet Online
OWNER’S NAME
PET’S NAME
Date

MonthDayYear
Date
I am over 18 years of age

YesNo
Pet Housed

IndoorOutdoorBoth
Phone # we can reach you at today
Please enter a valid phone number.
Email
example@example.com
WOULD YOU LIKE TO RECEIVE TEXT MESSAGES ABOUT YOUR PET’S PROGRESS WHILE THEY ARE IN THE CLINIC?

YesNo
NUMBER TO TEXT
If your pet has been seen at another clinic, is it ok to request records from the previous clinic?

YesNo
Clinic name and number
A routine wellness exam($40) is required once a year to ensure the health and well being of your pet. A new puppy/kitten wellness exam($47) is done at the first visit of any pet under the age of 1 year and includes a puppy/kitten care kit. (Up to $55 in value)
Your pet is due for the following Vaccinations/blood tests
Canine

Rabies- $29DHLP(Distemper)- $36Lyme- $44Bordetella(Kennel cough)- $31Lepto only- $27Heartworm/Lyme 4dx Test(Blood draw)- $50.00 NONE DUE
Feline

Rabies- $29FVRCCP (Feline Distemper)- $28Feleuk- $35Feleuk/FIV Test(Blood Draw)- $52.00NONE DUE
EXTRAS

Nail Trim ($27)Anal Gland Expression ($33)Fecal - basic ($46.34)
Does your pet need any flea, tick, or heart worm preventative today?

YesNo
IF YES, please select the number of doses you would like from the following
Canine Preventatives
Bravecto- 12 week flea/tick chewable tablet (ages 6 months+): #
Simparica Trio- Monthly flea/tick/heartworm/roundworm/hookworm: #
Sentinel Spectrum- Monthly heartworm/hookworm/roundworm/whipworm/tapeworm: #
(ages 6 weeks+)
Vectra- Monthly flea/tick topical (ages 8 weeks+): #
(ages 6 weeks+)
Feline Preventatives
Revolution- monthly flea/ear mite/hookworm/roundworm topical that comes with a free dose ofcestex which is an oral tablet that treats tapeworm (ages 8 weeks+): #
Bravecto- 12 week flea/tick topical (ages 6 months+): #
If you have any health concerns, please specify
Client Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Wellness/Vaccination Check-In Sheet Online

Your pet is due for the following Vaccinations/blood tests

IF YES, please select the number of doses you would like from the following

Canine Preventatives

Feline Preventatives