Patient History Form

Patient History Form
Your Name
Your Name
How would you like us to contact you?
Is your pet experiencing any of the following symptoms? Check all that apply:
Is your pet experiencing any of the following symptoms? Check all that apply:
Urgent Blood Work: If your pet is being brought in for vomiting, diarrhea, lethargy, decreased eating, decreased drinking, or on another urgent basis; running a blood profile in clinic will be an important part of the diagnostic process. Please indicate below whether we can proceed with blood work.
Routine Lab Work: If your pet is coming in for their annual visit please check the lab work.
If your pet is being seen for lameness, coughing, difficultly breathing, vomiting, abnormal urination, constipation or other Gastrointestinal issue, x-rays will be an important part of the diagnostic process. Please indicate below whether we can proceed with x-rays.
In the event further diagnostics and/or treatments are needed, please indicate how you would like us to proceed.
If you cannot provide proof of rabies certificate, your pet will be given the vaccine and you will be charged $15. All animals over 12 weeks are required by law to be up to date on rabies​.