DVH Illness Visit Questionnaire
Please note that due to the unprecedented circumstances involving the COVID-19 pandemic, we can no longer allow pet owners to accompany their animals into the hospital. We understand that this is a drastic measure, but it's for the protection of you, your family and our staff. This protocol has been recommended by the Pennsylvania Veterinary Medical Association. Please do not ask us for exceptions.

Please call us when you arrive to our facility and a technician will come outside and bring your pet into the hospital for examination. We will communicate via phone call to provide you with our assessment, diagnostics and treatment plan. Please remain in your car at our hospital for the duration of the appointment, unless we have specifically communicated otherwise.

Please make sure you bring a cell phone to the appointment for communication purposes. We thank you for your understanding.

Please answer the following questions in preparation for your visit to limit the face to face contact time required to take a medical history.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Pet's Name *
Cell Phone Number (to be used for communication during your appointment) *
Please describe the concerns you have with your pet *
Please tell us if you have noticed any of the following in your pet? 1.) Vomiting 2.) Diarrhea, 3.) Cough 4.) Lack of Appetite 5.) Change in Water Consumption 6.) Lameness(limping) 7.) Lethargy
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of dvhpc.com. Report Abuse