Skip to main content
Home
About Us
Team
Our Why
Our values
Our History
Join Our Team
Our Clients
Our Clinic
Take A Tour
Our Facilities
Getting your pet to Animal Medical Group
What to expect when you arrive
Things We Do
Additional Services
Anesthesia and Patient Monitoring
Breeding Services
Emergency and/or Extended Care
Grooming
Diagnostic
Medical Services
Pet Supplies
Preventive Services
Surgical Services
Wellness Programs
Pet Health
Pet Portal
I Want a Prescription Refill
Be Healthy Preventive Health Bundles
Be Healthy Loyalty Programme
Forms
Find Us
November Bundles
Request An Appointment
twitter
facebook
instagram
Consent Form for Day-time Admissions
Thank you for dropping off your pet with us today. This questionnaire helps to gather health information on your pet. Please be detailed and specific as much as you can.
Today's Date
Date Format: DD slash MM slash YYYY
Name
First
Last
Preferred Phone #
Alternative Phone #
Who do we contact to get permission to make medical or financial decisions?
Pet's Name
Breed
Chip Number
Sex
Colour
Reason for Visit (check all that apply)
Annual Wellness Exam
Six Months Wellness Exam
Vaccinations
Heartworm Screen
Blood Sampling
Faecal Analysis
Tick Fever Screen
Illness
Please specify if you selected 'Illness'
Are there any concerns for: (check all that apply)
Eating
Drinking
Bad Breath
Weight Loss
Itching / Scratching
Difficulty Standing
Scooting
Shaking Head
Lamenen
Vomiting
Diarrhoea
Skin Masses / Lesions
Urination Issues
When did your pet last eat?
Has your pet ever had an adverse reaction to any medications?
Yes
No
If yes, please describe
Has your pet ever had an adverse reaction to any vaccines, sedation, or any procedure?
Yes
No
If yes, please describe
Is your pet taking any medication(s)
Yes
No
If yes, please list medication(s)
Do you need a refill of these medication(s)
Yes
No
If yes, please list medication(s) in need of refill
Additional Services (Please indicate if you would like your pet to receive any of the following services)
Pedicure
Anal Gland Expression
Heartworm Preventative
Microchipping
Please call me if treatment fee will be over:
*if left blank, we will call if the fee is over $100
Consent
*
I give consent for day-time addmision.
Δ
Home
About Us
Team
Our Why
Our values
Our History
Join Our Team
Our Clients
Our Clinic
Take A Tour
Our Facilities
Getting your pet to Animal Medical Group
What to expect when you arrive
Things We Do
Additional Services
Anesthesia and Patient Monitoring
Breeding Services
Emergency and/or Extended Care
Grooming
Diagnostic
Medical Services
Pet Supplies
Preventive Services
Surgical Services
Wellness Programs
Pet Health
Pet Portal
I Want a Prescription Refill
Be Healthy Preventive Health Bundles
Be Healthy Loyalty Programme
Forms
Find Us
November Bundles
Request An Appointment
twitter
facebook
instagram