Curbside Medical History

Please have this form completed before coming to the hospital. You can email it back before your appointment or bring it with you. Your pet will be brought into the hospital by a team member, the doctor will do an exam and answer any questions/conversations by phone. Please have your cell phone ready and the number of that phone on this form. Payment services will be curbside as well, and expected after the visit is complete.

Client Information

Name(Required)
Address

Patient Information

MM slash DD slash YYYY
Species(Required)

Cats(Required)
Where does your feline pet reside?

Sex(Required)
Please enter todays date
MM slash DD slash YYYY

Please arrive 10 minutes before your appointment time. You may park in the parking lot on the east side of our hospital. If your pet is scheduled for routine annual exam / vaccinations, we also recommend yearly bloodwork and stool sample checks

Please call our office once you have arrived. 907-479-0001 Please let us know the make, color and model of your car. If you have any respiratory symptoms, fever and/or cough, have traveled recently or are in quarantine/had contact with anyone that may have coronavirus, please be sure to let our staff answering the phone know!

Please have your pet on a leash or in a carrier before we come to the car. Please bring a stool sample, so if needed it is available.

Medical History Questions

Briefly describe the reason your pet is here for an exam, such as ear infection, sick or limping. Please answer all questions below regardless of why your pet is here.

Coughing(Required)
Any coughing?

Sneezing(Required)
Any sneezing?

Vomiting?(Required)
Any vomiting?

Diarrhea(Required)
Any diarrhea?

When was the last time you saw your pet have a bowel movement and what did it look like?
Drinking(Required)
Any change in how much water your pet is drinking?

Urination(Required)
Is the patient urinating as he/she normally does?

Appetite(Required)
Has your pet’s appetite changed?

Brand, name on bag, how much, and and how often.
Diet Changes(Required)
Any change in diet?

Energy(Required)
Is your pet lethargic (not active)?

Orthopedic(Required)
Is your pet here because it is limping?

Pain(Required)
Has your pet cried out?
Eyes(Required)
Does your pet have a problem with one or both of its eyes?
Ears(Required)
Does your pet have a problem with one or both of its ears?
Teeth(Required)
Do you have any concerns with your pet’s teeth?
Skin(Required)
Are there any new lumps or bumps you have found?
Behavior(Required)
Have you seen any behavior changes?

Is your pet Microchipped?(Required)