Patient Admit Form

With curbside pet drop off and pick up, it will help expedite (pet’s name) appointment if you could fill in the following questions and send it back to the clinic by email before your appointment. Include as many details as you can. Please do not bring the document with you as we are not accepting paper as much as possible. Thank you

Patient Name:

Notes prepared by (client name):

Date and time of appointment:

Have you or anyone in your household been diagnosed with COVID-19?

Are you or anyone in your household experiencing symptoms of COVID-19? (cough, shortness of breath, fever) Have you or anyone else in your household been asked to self quarantine or self isolate in the last 2 weeks?

(If you answer yes to any of these questions, we can still see your pet, but we must discuss with you how we can do that safely prior to the appointment)

Reason for appointment.

What are the presenting problems?

When did you first notice these issues?

How has it changed since it started?

Please note the following for us about your pet:



Bowel movements:


Any vomiting or diarrhea?

Any lameness or stiffness?

Any coughing or sneezing?

Any recent (60 days) travel or boarding?

If you are presenting a cat, does he or she go outdoors?

Current Medications and supplements?


Is your pet up to date on vaccines and flea/tick/heartworm medication?

Current diet including treats:


Are you bringing any samples for your appointment? (eg urine, feces)

What else would you like us to know today?



What is your contact number during the appointment (cell phone in car)


After you have filled out the form,  you can copy and paste and send to: or print out and bring with you at you appointment time. 

  • Additional Services

  • Anesthesia and Patient Monitoring

    During surgery and other medical procedures, our team of veterinarians and veterinary technicians monitors all patients to ensure their safety. We monitor every procedure, regardless of whether it’s routine or more advanced. The type of anesthesia we use depends on…

  • Emergency and/or Extended Care

  • Health Screening Tests

  • Medical Services

    We are equipped to handle a wide variety of medical conditions, including emergencies. Because we can perform many diagnostic procedures in-house, we can often give you immediate answers and start treating your pet faster. In some cases, your pet may…

  • Pet Supplies

    We carry a variety of pet supplies to provide you with a selection of safe, vet-approved pet food, supplements, treats, toys, and accessories. Feel free to ask us any questions you might have about these products.

  • Preventive Services

    You can help keep your pet healthy by protecting him or her against parasites. Heartworms, fleas, ticks, and other internal and external parasites are much more than just pests; they can cause life-threatening conditions in your pet—and cause severe, potentially…

  • Surgical Services

    We provide many surgical services at our clinic including routine spay and neuters, soft-tissue surgeries and orthopedic surgeries. Occasionally, we refer our patients to specialists (board certified veterinary surgeons) to perform specialized surgeries.

  • Wellness and Vaccination Programs

    Our wellness and vaccination programs are designed to prevent disease and prolong the lives of your companion animals. Disease prevention is always less costly than dealing with the treatment of a disease once your pet has developed it. An example…