Appointment Pre Check-In Form

"*" indicates required fields

Name*

First Last

Today's Date*

Month

Day

Year

Has any of your contact information changed?*

Yes

Please provide updated contact information here

Do you live in Tarrant County?*

Yes

If No, please indicate which county you live in for Rabies vaccine purposes

Email*

For a copy of this form for your records.

Has your pet been seen anywhere else for any veterinary care?*

Yes

If yes, please notate the name and contact information of the clinic so that we can request the records.

Pet Information

Pet's Name*

Diet – What Brand/Type of food are you feeding your pet?*

Is it grain-free?*

Yes

Is it dry or canned?*

Dry

Canned

Does your pet get human food used as snacks or toppers? If so, please explain.*

What amount are you feeding and how often?*

Prevention – What flea and heartworm prevention is your pet on, if any?*

Do you need a refill?*

Yes

How many months would you like?

Please list any medications your pet is taking, including over the counter medication like Benadryl or any supplements

Medication/Supplement Name

Mg/Strength

How Often?

Click the plus sign to add more medications

Do you need any refills of these medications?

Yes

If "Yes" please list which medications you need refilled

What is the primary reason for your pet's visit?*

Do you have any medical concerns?*

Yes

If yes, please give details. Are the symptoms same/worse/better since when you first noted them?

Is your pet exhibiting any signs of pain?*

Scale of (no pain) 0-5 (severe pain)

Is this your pet's first visit? If so, please let us know how your pet typically does at the vet. Are there any helpful hints?*

Any history of aggression?*

Yes

If your pet has shown aggression, please explain the situation

Have you noticed any increased frequency of coughing or sneezing in your pet?*

Yes

If "Yes" please explain

Have you noticed any recent or consistent vomiting or diarrhea in your pet?*

Yes

If "Yes" please explain

Please rate your pets itch on a scale of 1-10 (This includes licking/scratching/shaking their head)*

(no itching) 1 2 3 4 5 6 7 8 9 10 (constant itching)

Have you noticed any change in your pet’s appetite?*

Yes

If "Yes" please explain appetite change

Have you noticed any change in your pets activity level?*

Yes

If "Yes" please explain activity changes

Have you noticed any changes in your pets water intake or urine output?*

Yes

If "Yes" what changes have you noticed?

Have you noticed any changes in your pet’s mobility i.e. difficulty getting up after sitting, stiff gait, limping?*

Yes

If "Yes" please explain mobility changes

Do you have any additional concerns or questions for the Doctor?*

Yes

If "Yes" please state your concerns or questions

Would you like to add another pet?*

Yes

Pet 2 Name*

What Brand/Type of food are you feeding Pet 2?*

Is it grain-free?*

Yes

Is it dry or canned?*

Dry

Canned

Does Pet 2 get human food used as snacks or toppers? If so, please explain.*

What amount are you feeding Pet 2 and how often?*

Prevention – What flea and heartworm prevention is Pet 2 on, if any?*

Do you need a refill for Pet 2?*

Yes

How many months would you like?

Please list any medications Pet 2 is taking, including over the counter medication like Benadryl or any supplements

Medication/Supplement Name

Mg/Strength

How Often?

Click the plus sign to add more medications

Do you need any refills of these medications for Pet 2?

Yes

What is the primary reason for Pet 2 visit?*

Do you have any medical concerns for Pet 2?*

Yes

If yes, for Pet 2 please give details. Are the symptoms same/worse/better since when you first noted them?

Is Pet 2 exhibiting any signs of pain?*

Scale of (no pain) 0-5 (severe pain)

Is this Pet 2's first visit? If so, please let us know how your pet typically does at the vet. Are there any helpful hints?*

Does Pet 2 have any history of aggression?*

Yes

If Pet 2 has shown aggression, please explain the situation

Have you noticed any increased frequency of coughing or sneezing in Pet 2?

Yes

If "Yes" please explain

Have you noticed any recent or consistent vomiting or diarrhea in Pet 2?

Yes

If "Yes" please explain

Please rate Pet 2's itch on a scale of 1-10 (This includes licking/scratching/shaking their head)*

(no itching) 1 2 3 4 5 6 7 8 9 10 (constant itching)

Have you noticed any change in Pet 2's appetite?*

Yes

If "Yes" please explain Pet 2's appetite change

Have you noticed any change in Pet 2's activity level?*

Yes

If "Yes" please explain Pet 2's activity change

Have you noticed any changes in Pet 2's water intake or urine output?*

Yes

If "Yes" what changes have you noticed in Pet 2?

Have you noticed any changes in Pet 2’s mobility i.e. difficulty getting up after sitting, stiff gait, limping?*

Yes

If "Yes" please explain mobility changes in Pet 2

Do you have any additional concerns or questions for the Doctor about Pet 2?

Yes

If "Yes" please state your concerns or questions for Pet 2

Would you like to add a 3rd Pet?*

Yes

Pet 3 Name:*

Diet – What Brand/Type of food are you feeding Pet 3?*

Is it grain-free?*

Yes

Is it dry or canned?*

Dry

Canned

Does Pet 3 get human food used as snacks or toppers? If so, please explain.

What amount are you feeding Pet 3 and how often?*

Prevention – What flea and heartworm prevention is Pet 3 on, if any?*

Do you need a refill for Pet 3?*

Yes

How many months would you like?

Please list any medications Pet 3 is taking, including over the counter medication like Benadryl or any supplements

Medication/Supplement Name

Mg/Strength

How Often?

Click the plus sign to add more medications

Do you need any refills of these medications for Pet 3?

Yes

If "Yes" please list which medications you need refilled for Pet 3

What is the primary reason for Pet 3's visit?*

Do you have any medical concerns for Pet 3?*

Yes

If yes, please give details for Pet 3. Are the symptoms same/worse/better since when you first noted them?

Is Pet 3 exhibiting any signs of pain?*

Scale of (no pain) 0-5 (severe pain)

Is this Pet 3's first visit? If so, please let us know how your pet typically does at the vet. Are there any helpful hints?*

Any history of aggression for Pet 3?*

Yes

If Pet 3 has shown aggression, please explain the situation

Have you noticed any increased frequency of coughing or sneezing in Pet 3?*

Yes

If "Yes" please explain

Have you noticed any recent or consistent vomiting or diarrhea in Pet 3?*

Yes

If "Yes" please explain

Please rate Pet 3's itch on a scale of 1-10 (This includes licking/scratching/shaking their head)*

(no itching) 1 2 3 4 5 6 7 8 9 10 (constant itching)

Have you noticed any change in Pet 3's appetite?*

Yes

If "Yes" please explain appetite change in Pet 3

Have you noticed any change in Pet 3's activity level?*

Yes

If "Yes" please explain activity changes in Pet 3

Have you noticed any changes in Pet 3's water intake or urine output?*

Yes

If "Yes" what changes have you noticed in Pet 3?

Have you noticed any changes in Pet 3’s mobility i.e. difficulty getting up after sitting, stiff gait, limping?*

Yes

If "Yes" please explain mobility changes in Pet 3

Do you have any additional concerns or questions for the Doctor for Pet 3?*

Yes

If "Yes" please state your concerns or questions for Pet 3

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Phone

This field is for validation purposes and should be left unchanged.

Appointment Pre Check-In Form

Pet Information

Call us today to book an appointment for your pet!
(817) 735-8700

Join Our Family

Hospital Policies

Hospital Affiliations

Services Offered

About Us

Appointment Pre Check-In Form

Pet Information

Call us today to book an appointment for your pet!(817) 735-8700

Join Our Family

Hospital Policies

Hospital Affiliations

Services Offered

About Us

Call us today to book an appointment for your pet!
(817) 735-8700