New Patient Check in Questions
Please complete this form ahead of your appointment with Vic West Pet Hospital so we may expedite your check-in! If you answer yes to any questions, please elaborate with details. Thank you and we will see you and your pet soon!
Your Last Name:
Primary Reason for appointment (please choose one and provide details below):
Annual Health Exam/Vaccinations
How Long has this been an Issue?
2 -7 days
Longer than a month
Has this been a problem before?
Any other issues in the past?
Any surgeries, other than spaying/neutering?
Any flea/tick medication, and if so, which one?
Is your pet on any other medication?
Last time your pet was dewormed?
Over 1 year
Last vaccinations for your pet:
Has your pet traveled at all recently?
FOR DOGS ONLY: Do they go on trails/camping?
FOR CATS ONLY: Are they indoor/outdoor?
Does your pet have any allergies that you are aware of?
Has your pet had any reactions to medications that you are aware of?
Is your pet on a special diet?
Are there any other pets in your house having a similar problem?
Please provide any further details about the reason for the appointment, if necessary:
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