cat sleeping

New Patient Check-In

*Required Fields

*Name
*Address
*Phone
Alternative Phone
*Email:
Pet Info:
*Pet's Name
*Age
Color
*Breed
If mixed, about how much does your pet weigh?
Sex
Spayed/neutered?
Species
*We have a few questions about coronavirus risk as this impacts precautions we take while handling pets.
  1. Has anyone in your household had flu-like symptoms, been exposed to coronavirus, been under quarantine for coronavirus, or been diagnosed with coronavirus during the past two weeks? If yes, explain:
Questions about your pet’s previous health:
Rabies vaccine last given
DHPP (Dog) or RCP vaccine (Cat) last given
Lepto (Dog) or Leukemia (cat) last given
Bordetella last given
Has your pet ever had a vaccine reaction?
If so, describe
*On heartworm prevention?
What kind?
*On flea prevention?
What kind?
*What food does your pet eat?
*Any supplements/people food
*Has your pet had any medical concerns in the past / any history of illness? If so, please explain:
*Does your dog spend time outdoors where wildlife live (for instance access to creeks, lakes, roaming outdoors, camping)
*Does your dog go to a groomer or boarding facility or do you work or volunteer in a grooming/boarding/kennel facility?
*Are there any people in contact with this dog who are immunosuppressed?
*Is your pet friendly with strangers? If no, provide details of what sort of situations he/she is not friendly in
*Primary Concern Today
Duration of symptoms
Getting better/worse?
*How is your pet feeling?
*Appetite
*Drinking/urination
*Any vomiting?
*Any diarrhea?
*Any coughing, sneezing, or nasal discharge in the past two weeks? If yes, describe
*Has your pet had a similar problem in the past?
*Is there anything else we need to know?
Please note: We will do an examination and basic testing/medications (such as giving pain meds to a painful pet) and then Dr. Jordan will give you a call to discuss the treatment plan. Typically the cost of the initial exam, tests, and meds is $100-250. If it is over $250, we will call you to discuss prior to performing tests/treatments. Once we have completed tests and treatments, we will call you and set up a pick up time. We will take payment at that point over the phone. Do you have any questions or concerns?