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Patient Intake form

Patient Intake form

Please complete the questions and a staff member will be with you shortly to pick up your pet from the car. Thank you for your cooperation as we adapt to the new COVID 19 safety guidelines.  Please call the clinic when you arrive 405-279-2727 
13Questions
  • 1
    Human First Name and Last Name
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  • 2
    Pet's Name
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  • 3
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    Pick a Date
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  • 4
    Why did you bring your pet in today?
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  • 5
    What heartworm prevention are you currently using? Do you need a refill? When was your pet's last dose given?
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  • 6
    What type of flea and tick prevention are you using? Do you need a refill? When was your pet's last dose given?
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  • 7
    What type of food do you currently feed your pet? How much do you feed and how often? What kind of treats does your pet get?
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  • 8
    What medications or supplements do you currently give your pet?
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  • 9
    Is your pet currently showing any signs of coughing, diarrhea, or vomiting?
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  • 10
    Please select which vaccination package you would like today if you are here for vaccinations. If you are not here for vaccinations, please skip this question.
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  • 11
    Please select any add-on services you would like to your package
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  • 12
    Please provide a history of any medical issues that we need to be aware of. If you pet is here for a problem focused exam (sickness), please provide a list of symptoms including when they started. The more detail, the better. Thank you!
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  • 13
    Please select how you plan to pay today
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  • 14
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