We look forward to seeing you at your upcoming appointment! Please complete the questionnaire below in advance to prevent a delay to your appointment check-in.

• If your pet requires medication in order to stay calm during an appointment, please give at the appropriate time as directed by your veterinarian. If you need a refill or have forgotten to administer your pet’s medication, please call us ASAP at 740-373-9696. Arriving without administering the required medication will result in significant delays or rescheduling.
• Upon arrival please come to the lobby to check in. Our lobby is open and we have coffee and snacks available! If you would like to wait in your car, we will give you a buzzer in order to notify you when we can see you.

Wellness Exam Pre-Appointment Questionnaire

Name(Required)

First Last

Name of person attending appointment(Required)

First Last

Email(Required)

Pet's Name(Required)

First

Appointment Date(Required)

MM slash DD slash YYYY

Appointment Time(Required)

Hours

:

Minutes

AM PM AM/PM

Do you need an estimate for your appointment today?(Required)

Yes

No

Does your pet need any vaccinations today?(Required)

Yes, please give any required vaccinations.

Yes, I would like to know what is due and decide then.

No, my pet is up to date and I don't need any vaccinations given.

No, I decline all vaccinations.

Has your pet ever had any kind of a vaccine reaction?(Required)

Yes

No

If your pet has lab work, how would you like the results communicated to you?

Text Message

Email

Phone Call

Do you have any concerns or questions you would like addressed at your appointment? Please be as specific as you can.(Required)

Is your pet experiencing any coughing, sneezing, vomiting, or diarrhea?(Required)

What does your pet eat on an average day? Please include pet food, treats, dental chews, and any people food or homemade food with the frequency, amount, and brand.(Required)

What medications/supplements is your pet on? Do you need any refills?(Required)

Is your pet on parasite control? What brand and when did you last administer/apply the medication?(Required)

Tell us a little bit about your pet's lifestyle! Indoor/outdoor? Daycare? Travel History? Loves/hates other animals? Has lots of pet siblings?(Required)

I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of the appointment. The individual bringing my pet to the appointment is authorized to request services and communicate what my pet needs.(Required)