Appointment Check-In

Petcare Animal Hospital

Fields marked with an * are required

Name *

First

Last

Pet Name *

Phone number for contact during appointment *

Email *

Address *

Address Line 1

City

State

Zip Code

Has anyone in the household been diagnosed with COVID-19 or is currently ill? *

Has your pet taken any medications in the past 2 weeks? If yes, please list below.

What food does your pet eat? *

What is the reason for your visit? Please be as detailed as possible (e.g. When did it start? How often does it happen? Is it getting worse?). *

Would you be interested in a video visit through the Zoom app (app download required)? *

Who will be bringing your pet to the appointment? *

Is this person authorized to make medical and financial decisions for your pet? *

Yes, they are authorized to make financial and medical decisions.
No, they are NOT authorized to make financial and medical decisions. I will be available for questions at the number provided.