Clone of 2025 Main Form

PRACTICE STANDARDS & OPERATIONAL POLICIES

Professional Integrity Our medical team is dedicated solely to the well-being of our patients; our staff does not work on a commission or sales-incentive basis.

Weekend & Urgent Care Services On Saturdays and Sundays: Stittsville Kanata Vet Hospital operates as an urgent care facility. Please note the following weekend protocols:

Service Scope: Routine services, such as vaccinations, are not performed on weekends to prioritize urgent medical needs.

Consultation Fees: Weekend consultation fees are higher, consistent with local urgent care and emergency standards, reflecting limited veterinary availability.

Unified Pricing: Costs for diagnostics, laboratory tests, and medications remain the same regardless of the day of the week.

CLINICAL EXPECTATIONS & PHYSICAL EXAMINATIONS

The Value of Your Pet’s Examination A Screening-Level Examination provides a vital baseline assessment of your pet's health at the time of presentation. Because medical conditions are dynamic and can evolve rapidly, this assessment reflects your pet's status at a single point in time and may not identify subclinical conditions, such as intermittent heart murmurs or subtle neurological changes, that are not externally detectable without a Focused Evaluation.

Ongoing Monitoring & Partnership Effective veterinary care is a partnership between the clinic and the home. We rely on your proactive monitoring of your pet’s behavior and health status following your visit. Should you notice any new symptoms, persistent concerns, or changes in your pet’s condition, we encourage you to contact us promptly for a problem-focused evaluation.
Please read each option and tick mark it to proceed.

Veterinary-Client-Patient Relationship (VCPR) is established once my pet is examined; emergencies are limited to the specific issue presented. ANNUAL CONSULTATIONS are required to maintain VCPR. Patients who have not been examined by a veterinarian at our clinic within the past 12 months are considered inactive. Reactivation is subject to availability and may require booking as a new patient.SKVH may refuse ongoing care at its discretion. If you are only coming in for urgent care, we do not automatically become your regular veterinarian. Please contact staff if you'd like us to be your regular vet clinic.SERVICES include examinations, preventive care, diagnostics, treatment planning, urgent care during business hours, and client education. Diagnosis may not always be final, and recommendations may change if new clinical signs develop.Accurate and complete information about my pet’s health must be provided. Treatment plans must be followed, including medications and follow-ups. Changes in my pet’s condition or seeing another VETERINARIAN MUST BE COMMUNICATED PROPERLY.Full financial responsibility applies for all services rendered, including charges authorized by my proxy. Payment is due at the time of service. Non-payments may be SENT TO COLLECTIONS AND REPORTED TO CREDIT BUREAUS without further notice.CANCELLATION & RESCHEDULING: To respect the time of our medical team and other patients, we require at least 24 hours’ notice for canceling standard appointments and 48 business hours for surgical procedures. Cancellations must be made by direct phone call during business hours; if the clinic is closed, a timestamped email must be sent to serve as your legal notice to avoid a $75 cancellation fee or the forfeiture of the $325 surgery prepayment.All consultations, diagnostics, treatments, medications, and products are non-refundable. Medications CANNOT BE RETURNED under any circumstances. Services and products must be chosen carefully. SKVH may use COMPOUNDED, OFF-LABEL, OR EXTRA-LABEL DRUGS when medically necessary. Compounded drugs are custom-made preparations; off-label or extra-label use means using an approved drug in a manner not specified on its label, following veterinary guidelines.SKVH sends healthcare REMINDERS VIA EMAIL, TEXT, AND APP only. Declining digital communication releases SKVH from responsibility for missed reminders. No mailed reminders will be provided.NO GUARANTEES are made regarding diagnosis, prognosis, or treatment outcomes. Veterinary care carries risks, including worsening of condition, complications, and death. Emergency procedures may be performed without consent if contact is not possible, and associated costs are the client’s responsibility.In cased of HARASSMENT, YELLING, DEFAMATION OR UNSAFE BEHAVIOR your file will be immediately maked for termination. We will provide you with a reasonable opportunity to arrange for the services of another veterinarian. During this transition, we will transfer your pet's medical records to the provider of your choice.For medical emergencies occurring outside of our regular business hours, please contact Alta Vista Animal Hospital or any nearby 24h clinic for immediate assistance.
AI Scribe System – To help ensure accurate and complete medical records, we may use a secure AI medical scribe during your pet’s visit, similar to what many family physicians already use. This tool assists the veterinarian with documentation only and does not replace their clinical judgment. Do we have your permission to use this tool today?
AI Scribe System*

YesNo
Have you, your partner or any of the pet's co-owners' files been terminated within the past 5 years.*

YesNo
What tentative date and time for your appointment have we provided you? If you have not spoken to us regarding this appointment, please do not complete this form.*
Name of your pet's insurance company (mandatory)*
(eg: Trupanion / Petsecure /Pets Plus Us / OVMA / None ) Write 'None' if your pet is uninsured.
Other vet clinics / hospitals that you have been to with your pets?*
REQUIRED BY REGULATION & TO RECEIVE AND SEND FILES TO THAT CLINIC.
Owner's Name*

First NameLast Name
Has THIS PET been seen by a veterinarian at SKVH before FOR A CONSULTATION. Click no if you are not sure.*

YesNo
Pet Owner's Address*
Cell Number for texting & calling*
Please enter a valid phone number.Format: (000) 000-0000.
Email address of primary owner*
example@example.com
Occupation of primary owner*
PET CO-OWNER OR EMERGENCY CONTACT: I designate the individual listed below as an Authorized Agent for my pet. I explicitly grant this person the authority to make medical and financial decisions on my behalf, including providing Informed Client Consent for treatments, anesthesia, or surgery, should I be unreachable. I understand that their decisions are legally binding as though I had made them myself.*

First NameLast Name
Phone Number of Pet co-owner / Emergency Contact*
MandatoryFormat: (000) 000-0000.
Email address of secondary owner / Emergency Contact
(leave empty if no secondary owner)
Occupation of Pet co-owner or Emergency Contact*
(Mandatory to have one or the other)
How many pets are you registering today ?*

OneMultiple

non-active field*

First NameLast Name
Pet's Name*
Pet's Date of Birth*

YearMonthDay
Date
Species*
Breed*
Color*
Sex*
Microchipped*
Is your pet on any MEDICATIONS including heartworm / tick / flea / supplements etc ? Which ones? What dose and how often ? Do you need any refills ? Write 'none' if your pet is not on any medications.*
FOOD / TREATS / DIET ? Which ones?*
Vaccine / Wellness / Pre-surgery check: (No medical issues are covered in this exam, only a basic exam to verify your pet is healthy for vaccines. Please select 'Medical Issues' if you'd like the vet to go over any issues / concerns. UNFORTUNATELY, WE CANNOT ADD MEDICAL ISSUES IN THIS EXAM. Please select carefully.
Reason for visit. We cannot combine vaccines with medical appointments.*

Consultation - required to determine health of patient prior to administration of vaccines, NO MEDICAL ISSUES ARE ADDRESSED IN THIS CONSULT. Select next option if you have any medical questions.Consultation - Minor, major medical Issue or an emergency.Surgery Prepayment
Select all that apply

If your cat was adopted from a barn or a multi cat household, then your cat may be a candidate for recommended Feline Infectious Virus / Feline Leukemia Virus Test. Please search online for these hidden diseases and select this option to enquire about testing. $200.Is you dog due for ANNUAL Heartworm / Lyme / Ehrlichia / Anaplasma Test ? $ 118
Which recommended parasite prevention medications are you interested in ? This is part of wellness routine ?- (select all that apply). If you decide to opt out of it now, we will not be able to dispense it later on in case you see worms or mites. YOUR PET WILL NEED TO BE SEEN AGAIN FOR A CONSULTATION FOR THAT MEDICAL ISSUE.*

Intestinal Parasites (Dogs should get this all year round or during spring, summer and fall) - (Indoor cats should get this every 3 months at least and outdoor cats should get it every month as preventatives)Heartworm (Recommended from May to November)Ticks (Recommended anytime temperature is above 0 C for a week or above, usually dine from March to December)Mites (puppies, old pets, immunocompromised pets or in case of infestation)NoneFleas (when you bring new pets home, or in case of infestation)
Vaccines Up to date ?*

YesNoUnsure
Please list names of all PAST medical conditions (that SKVH vets have not seen your pet for). This is very important.*
Select all applicable clinical signs that you are concerned about.*

CoughingSneezingVomitingDiarrheaConstipationUrinationAppetiteDental IssuesWater IntakeEnergyBehaviorWeight ChangeSkin IssuesLimping / Stiff / Not walking properlyAnal GlandsLumps / MassesBreathing IssuesEyesEarsNosePawsNailsStretching body and neckParasites seenSeizures / Collapse / Stroke / UnconsciousVaginal DischargePenis DischargeOther
Coughing - started how many days ago?*
Coughing - how many times?*
Coughing - when does it happen?*

AnytimeWhen sleepingDuring the dayWhen excitedWhen exercisingDuring certain seasonWhen pulling on leashOn walksOther
Coughing - correlation *

Went to daycare / boarding recently, in contact with other petsVaccinated with Kennel CoughNot vaccinated with Kennel CoughAte something that he / she shouldn't have
Coughing - what is brought up?*

NothingPhlegmFoamMucusVomit
Sneezing - started how many days ago?*
Sneezing - what is brought up?*

NothingMucus dischargeGreen dischargeBlood dischargeGrey DischargeClear discharge
Sneezing - which side?*

LeftRightBoth
Sneezing - how many times a day*

OccasionallyFrequentlyRarelyDailyHourlyMultiple times an hour
Vomiting - started how many days ago?*
Vomiting - how many times a day*

Once a monthOnce a weekEvery few days12345678910
Vomiting - What is brought up ?*

NothingFoodBileFoamGreenish stuffBloodOtherGrass that was eaten
Vomiting - happens how much time after eating. Write 'NA' if no correlation.*
Vomiting - My pet may have gotten into things like toys, foam, tamp[ons, clothers, plastic, string, toys etc*

YesNoMaybe
Diarrhea - started how many days ago?*
Diarrhea - how many times a day*

Once a monthOnce a weekEvery few days12345678910
Diarrhea - Select all that apply?*

Food in fecesWatery fecesFoam in fecesGreen fecesRed Blood in feces (lbd)OtherGrass in fecesOrange fecesExplosive diarrheaMucus in feces (lbd)Weight Loss (sbd)Volume of actual feces in diarrhea-Dereased (lbd)Volume of actual feces in diarrhea- Inreased (sbd)Brown Blood in feces (sbd)
Diarrhea - is your pet currently on any parasite prevention ?*

YesNoNot sure
Diarrhea - is your pet straining to defecate ?*

Yes (lbd)No (sbd)Not sure
Diarrhea - is your pet asking to go out more frequently ?*

NoNot sureMild increase in frequency (sbd)Moderate to Large increase in frequency (lbd)
Constipation - started how many days ago?*
Constipation - is your pet straining to defecate ?*

YesNoNot sure
Urination - started how many days ago?*
Urination - select all that apply.*

Increased frequencyDecreased frequencyIncreased VolumeDecreased volumeBlood tingedStrainingLicking private areasSquats every few stepsDripping in sleepDripping when walkingPooling urine in sleepPooling urine when sitting
Appetite Change - started how many days ago?*
Appetite*

IncreasedDecreasedNot eatingEating anythingEating only junk food / treats
Energy - started how many days ago?*
Energy*

IncreasedDecreased
Dental Issues - started how many days ago?*
Dental Issues - what do you see.*
type your dental concerns here.
Water Intake Change - started how many days ago?*
Water Intake*

IncreasedDecreased
Behavior Change - started how many days ago?*
Behavior - please explain what changes you see.*
Weight Change - started how many days ago?*
Weight Change*

IncreasedDecreased
Skin Issues - started how many days ago?*
Skin Issues - what do you see ?*
Limping / Stiffness - started how many days ago?*
Limping / Stiffness - which leg, what's the issue ?*
Anal Gland Issues - started how many days ago?*
Anal gland Issues - which side, what's the issue ?*
Lumps / Masses - started how many days ago?*

Breathing Issues - started how many days ago?*
Breathing Issues - what is going on, please describe.*
Eye Issues - started how many days ago?*
Eye Issues*

Left Eye affectedRight Eye affectedLeft Eye squintingRight Eye squintingLeft Eye 3rd eyelid persistentRight Eye 3rd eyelid persistentLeft Eye unable to openRight Eye unable to openLeft Eye cherry eyeRight Eye cherry eyeLeft Eye rednessRight Eye rednessLeft Eye bulgingRight Eye bulgingLeft Eye decreased visionRight Eye decreased visionLeft Eye clear dischargeRight Eye clear dischargeLeft Eye cloudyRight Eye cloudyLeft Eye green / mucus dischargeRight Eye green / mucus dischargeLeft Eye pupil smaller than the otherRight Eye pupil smaller than the otherLeft Eye bloodshotRight Eye bloodshotLeft Eye - scratching / pawingRight Eye - scratching / pawing
Ear Issues - started how many days ago?*
Ear Issues*

Left ear - hematoma / bulgingRight ear - hematoma / bulgingLeft ear - pawing at earsRight ear - pawing at earsLeft ear - dirty / debrisRight ear - dirty / debrisLeft ear - scabsRight ear - scabsLeft ear - excessive waxRight ear - excessive waxLeft ear - rednessRight ear - rednessLeft ear - odorRight ear - odorLeft ear - squishy soundRight ear - squishy soundLeft ear - clear dischargeRight ear - clear dischargeLeft ear - pus dischargeRight ear - pus discharge
Nose Issues - started how many days ago?*
Nose Issues*

Left side - clear dischargeRight side - clear dischsrgeLeft side - congestedRight side - congestedLeft side - green / mucus / yellow dischargeRight side - green / mucus / yellow dischargeLeft side - blood dischargeRight side - blood dischargeLeft side - constant dripping dischargeRight side - constant dripping dischargeLeft side - pusRight side - pus
Paw Issues - started how many days ago?*
Paws - please describe*
Nail Issues - started how many days ago?*
Nail - please describe*
Stretching body & Neck - started how many days ago?*
Seizures - started how many days ago?*
Seizures - describe the episodes
Parasites seen - started how many days ago?*
Please describe anything that was not an option above. Or add more details about your concerns.*
Type 'NA' if not applicable.

NON-CANCELLABLE PRIORITY Weekday Consultation with screening exam	Appointment within 24 hours of form submission. Diagnostic costs remain the same regardless of the day.	$ 195 + HST
Non-Priority Weekday Consultation with screening exam – Vaccines (Medical issues not addressed)	Appointment scheduled for after 24 hours of form submission. Minimum 24-hour cancellation notice by phone required; cancellation fee of $50 + HST applies. Diagnostics costs remain the same any day. Appointments cannot be cancelled or rescheduled if less than 24 hours remain.	$ 115 + HST
Non-Priority Weekday Consultation with screening exam – Medical Issues	Appointment scheduled for after 24 hours of form submission. Minimum 24-hour cancellation notice by phone required; cancellation fee of $50 + HST applies. Diagnostics costs remain the same any day. Appointments cannot be cancelled or rescheduled if less than 24 hours remain.	$135 + HST
Weekend/STAT Holiday – Any Consultation with screening exam	Non-cancellable once booked. Diagnostics costs remain the same any day. Applies to any appointment scheduled on weekends or statutory holidays.	$225 + HST

I agree to all the terms & conditions mentioned above including the appointment cancellation fees (available on www.skvh.ca*
Sorry, you cannot fill this form out unless you receive a 'Tentative Date & Time" for your appointment. Please text us at 343-463-8787 asap. You should receive a quick response during our working hours.
Should be Empty:

Rows	Name	Date of Birth	Species	Breed	Color	Sex	What needs to be done in the appointment ?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6
Pet 7
Pet 8

Rows	Lump 1	Lump 2	Lump 3	Lump 4	Lump 5
Where is this lump ?
When did you first see it ?
Growing Fast ?
Any discharge ?
Other notes ?