Who is bringing the pet in?
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First Name
Last Name
Phone number:
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What is your pet's name?
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This visit is for:
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[Select one.]
Please describe the visit in further detail here.
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[For example, "vomiting for the past 5 days," "wellness exam and vaccines", or "coughing has improved ." If there are several issues you are concerned about, include all of them here.]
Does your pet show any of the following: coughing/sneezing/vomiting/diarrhea?
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Check all that apply.
My pet is:
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Check all that apply.
If your pet is having any of the above abnormally, please provide details below (including how long this has been going on).
[For example, "he has been vomiting for 4 days.']
List any medications, INCLUDING FLEA CONTROL, supplements and over the counter products that you use, and how often they are administered. (If none, type "none.")
[Please do not write "on file," or "the same," as we need your information to be updated every visit, even if nothing has changed. For example: Pet Tab Vitamins, one every 2 days.]
CATS ONLY: My cat is:
[Select one option only:]
DOGS ONLY: My dog:
[Check all that apply:]
If there is anything else you would like to discuss with us during your visit, please let us know below:
[For example, "I need a prescription for flea control refilled," or "I have a pet insurance form that will need to be completed."]
Please read and agree to the Terms of Service:
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EFFECTIVE 1/1/2021: The Family Vet is a wellness clinic. Our office hours are limited to Sundays only, and all visits to our office require an appointment. We do not provide emergency/critical care nor anesthesia and radiology services. Medical problems both urgent and non-urgent may be referred to other local clinics.