Additional Pet Form
Full Name
*
First Name
Last Name
Phone Number
*
Primary
Format: (000) 000-0000.
Email Address
*
If you do not have an email address, type None.
Do you have your pet's medical history?
*
Yes, I have my pet's medical history.
No, my pet has never been to a vet before
No, I do not have my pet's medical history.
Please Upload any medical history documents:
Pet's name
*
Age
*
Species
*
Sex
*
Female
Female - spayed
Male
Male - Neutered
Unknown
Breed
*
Color
*
Any medical allergies?
*
History of adverse reactions after receiving vaccines (facial swelling, vomiting, diarrhea, Hives, Difficulty Breathing, collapsing)
*
Yes
No
Current medications/treatments
*
What best describes your pet's lifestyle?
*
Strictly Indoors
Primarily indoors with some outdoor activities
Primarily outdoors with some indoor activities
Strictly outdoors
Microchipped?
*
Yes
No
Reason for Visit
*
Does your pet show any reluctance to getting in the carrier or car?
*
Yes
No
How would you describe your pet's behavior during travel? (select all that apply)
*
Eager and Excited
Subdued/more quiet than usual
More vocal than usual
Does your pet do any of the following during travel? (select all that apply)
*
Pant
Hide
Poop
Tremble
Drool
Pee
Pace
Vomit
None of these
Are there any situations that your pet has tried to avoid or seemed to dislike in the past? (select all that apply)
*
Entering the Vet hospital
Going in to the exam room
Ear exam/cleaning
Unfamiliar people or animals
Nail trim
Being weighed
Having a rectal temperature taken
Other
Has your pet ever been prescribed any medications to help manage their fear or anxiety associated with the visit?
*
Yes
No
Do you think that your pet would benefit from medication to help manage their fear or anxiety around their upcoming vet visit?
*
Yes
No
Maybe
Submit
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