Appointment Intake Form

Please fill out this form if you have an upcoming appointment with us.

Name *

First

Last

Preferred Name (If different from above):

Preferred Pronoun:

Pets Name *

Email

Do you have any concerns with your pet at this time? *

Is your pet experiencing any coughing, sneezing, vomiting or diarrhea? *

Has your pet experienced any change in drinking and/or urination? *

For cat pet parents only: Is your pet using the litter box?

What brand of food is your pet currently eating? How much food do they receive daily? *

Does your pet receive any other treats/food items? If so, what do they receive? *

Please list the current medications your pet is taking and how often you are giving them: *

Please list any supplements your pet is receiving: *

Is your pet receiving any parasite prevention? If so, please list the name of the prevention below. *

Does your pet go to any boarding facilities or off leash dog parks? *YesNoNot Applicable

Does your cat go outside or on a deck? If so, is it supervised or not supervised? *Yes, supervisedYes, unsupervisedNoNot Applicable

Do you have any other pets in the house? If so, please provide their species and age: *

Are you interested in the wellness plan that we offer? If you are not familiar with them, details can be found at the link below. If you have any questions, please give us a call to discuss this prior to your appointment *

https://www.baywoodsouthanimalhospital.ca/index.php/wellness-plans/

Are you willing to proceed with lab work if this is the doctor's recommendation? *

Any additional comments

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