Appointment Form
Please complete this form at least an hour prior to your appointment with us. This will allow us to review the information before you arrive at the clinic, and let our medical staff determine if there are any other questions we need to ask. If you have any questions or concerns, please call us at 918-481-1693. THIS FORM IS REQUIRED FOR US TO BEGIN YOUR APPOINTMENT. THESE ARE THE SAME QUESTIONS WE WOULD ASK YOU AT EVERY APPOINTMENT. A NEW FORM WILL BE REQUIRED FOR EVERY APPOINTMENT
What is your name (Please include first and last name)? *
What is your pet's name? *
What date is your appointment?
What is the best phone number to reach you at during your appointment, so we can call you to discuss the exam findings? THIS IS THE NUMBER WE WILL CALL TO DISCUSS EXAMS AND CHARGES. PLEASE LIST THE NUMBER THE DOCTOR WILL CALL TO GO OVER THE EXAM. (If you would please format the phone number as xxx-xxx-xxxx, we would appreciate it!) *
What is the best email address to send you any instructions the Veterinarian has for you? *
What is the reason for your pet's appointment? *
When did you first notice these issues with your pet? *
How much time does your pet spend outside on a daily basis? *
Has your pet come into contact with any other animals in the last 2 weeks? (boarding, dog park, grooming, out on walks, through the fence, etc) *
Is your pet on any medications, prescribed or over the counter? IF YES PLEASE LIST MEDICATIONS, STRENGTH, AND FREQUENCY THAT YOU ADMINISTER MEDICATIONS. *
Is your pet current on heartworm prevention? IF YES, WHAT BRAND, AND WHEN WAS THE LAST DOSE ADMINISTERED? *
Is your pet current on flea and tick prevention? IF YES, WHAT BRAND, AND WHEN WAS THE LAST DOSE ADMINISTERED? *
What food are you feeding your pet? PLEASE LIST BRAND, AMOUNT, AND FREQUENCY IN WHICH YOU FEED. *
Has there been any change in your pet's diet in the last 7 days? (Change in food, table scraps, gotten into the trash, etc) *
Has there been any change to your pet's attitude, IF YES PLEASE DESCRIBE. *
Has there been any change to your pet's food intake or water intake, IF YES PLEASE DESCRIBE. *
Where was your pet last vaccinated? *
If your pet has been having any diarrhea or vomiting, please describe and how often has it been happening? *
Is there any discharge or drainage from the nose or eyes? Please describe. *
Has there been any coughing or sneezing recently? *
Have you noticed your pet scratching or chewing? If so, what area(s) is/are the main focus? *
Do you have any other questions or concerns for the doctor today?
If we cannot reach you, we will NOT perform any testing or treatment beyond the medical exam. Please type your initials below to state you understand. For drop off appointments, we can not guarantee a specific pick up time. We will keep in touch with you throughout their visit with us, and will let you know as soon as they are ready to go home. *
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