Forms

Use links below to submit forms online

One pet per form, do not combine multiple pets on a form.

Scheduled exam appointments, complete Health Questionnaire for Exams prior to your visit.

Scheduled sedation, surgery or dental appointments, complete Pre-sedation Form prior to your visit.

Interested in grooming, boarding or day care? View pricing and requirements by clicking the links below.

Grooming Click Here for Bubbles & Bows Salon

Boarding/ Day Care Click Here for Bed & Biscuit Inn

New Patient Form

Step 1 of 2

50%

Have you been to our facility before?(Required)

Yes

If known, please include account number on receipt from previous visit

How did you hear about us?(Required)

Owner

Owner Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Type(Required)

Landline

Mobile

Email(Required)

Add Second Owner?(Required)

Yes

Name(Required)

First Last

Relationship(Required)

Spouse

Significant Other

Relative

Friend

Other

Phone(Required)

Type(Required)

Landline

Mobile

Animal

One form pet pet

Animal Name(Required)

Species(Required)

Dog

Cat

Breed(Required)

Color(Required)

Sex(Required)

Male

Female

Spayed or Neutered?(Required)

Yes

Age(Required)

Weeks

Months

Years

Date of Birth

If known

Do you a have a pet health insurance policy?(Required)

Yes

Who is your pet health insurance provider? Please provide policy number.(Required)

Are you interested in learning more about pet health insurance?(Required)

Yes

Primary Reason for Visit(Required)

Upload Vet Records

Drop files here or

Max. file size: 100 MB.

Health Questionnaire for Exams

Step 1 of 13

Date of Appointment(Required)

Owner

Owner Name(Required)

First Last

Phone(Required)

Animal

Animal Name(Required)

History

What is the primary reason for the visit?(Required)

Is your pet microchipped?(Required)

Yes

Are you interested in getting your pet microchipped during your visit?(Required)

Yes

Is your pet on any medications, supplements, flea/tick or heartworm prevention?(Required)

Yes

Please list current medications(Required)

Name of medication

Strength (mg)

Current dosage

Use the + to add additional line items

Is your pet due for any vaccinations?(Required)

Yes

Unsure

Please provide vaccination records, if done at another facility

Max. file size: 100 MB.

Does your pet engage in social activities?(Required)

Boarding or daycare

Grooming

Walks

Dog parks

Spending time outside (for cats)

No, my pet does not socialize outside my home

Select all that apply

Does your pet travel with you?(Required)

Yes

What type of travel activities is your pet involved in?(Required)

What is your pets current attititude?(Required)

Alert and active

Depressed or lethargic

How long has your pet been depressed or lethargic?(Required)

Do you have any concerns with your pets eyes?(Required)

No, eyes are normal

Rubbing eyes

Squinting

Redness

Discharge

Vision problems or blindness

How long have your pets eyes been an issue?(Required)

Has your pet been bathed recently?(Required)

Yes

Do you have any concerns with your pets ears?(Required)

No, ears are normal

Shaking head

Scratching or rubbing ears

Redness

Discharge

Odor

Pain

Hearing problems or deafness

How long have your pets ears been an issue?(Required)

Has your pet been bathed recently?(Required)

Yes

Is your pet coughing?(Required)

Yes

How long has your pet been coughing?(Required)

Is the cough productive, moist or dry?(Required)

Productive

Moist

Dry

Is your pet having difficulty breathing?(Required)

Yes

Is the cough worse at a certain time during the day?(Required)

Yes, worse in the morning

Yes, worse at night

No, the cough is the same day and night

Is your pet wheezing, rapid breathing or sneezing?(Required)

Wheezing

Rapid breathing

Sneezing

No wheezing, rapid breathing or sneezing

How long has your pet been wheezing, rapid breathing or sneezing?(Required)

Do you have any concerns with your pets skin?(Required)

No, skin is normal

Scratching or icthy

Flakes, scales or crusts

Hair loss

Rash

Lumps, bumps or masses

Is the itching in one area or all over?(Required)

One area

All over

Has the lump, bump or mass changed in size?(Required)

No change

Yes, has increased in size

Yes, has decreased in size

How long has lump, bump or mass been present?(Required)

How long as your pet had issues with skin?(Required)

Do you have any concerns with your pets mouth or teeth?(Required)

No, mouth and teeth are normal

Bleeding from the mouth

Difficulty chewing or eating

Odor from the mouth

How long as your pet had issues with mouth or teeth?(Required)

What brand or type of food are you feeding?(Required)

How is your pets appetite?(Required)

Eating normally

Decreased food intake

Not eating at all

Increased appetite

How long has your pets appetite been abnormal?(Required)

How is your pets water consumption?(Required)

Drinking normally

Decreased water intake

Not drinking at all

Drinking more than usual

How long has your pets water intake been abnormal?(Required)

Is your pet vomiting?(Required)

Yes

Did your pet eat anthing out the of ordinary?(Required)

Yes

When and what what eaten?(Required)

Do you have any concerns with bowel movements?(Required)

No, stools are normal

Soft stools or diarrhea

Mucous in stools

Bloody stools

Pain, difficulty or straining

How long have bowel movements been an issue?(Required)

Do you have any concerns about urination?(Required)

No, normal urination

Difficulty or straining

Blood in urine

Dripping urine or incontinence

How long has urination been an issue?(Required)

Do you a have a pet health insurance policy?(Required)

Yes

Who is your pet health insurance provider? Please provide policy number.(Required)

Are you interested in learning more about pet health insurance?(Required)

Yes

Is there anything else you would like us to know for this visit?(Required)

If your pet is coughing, sneezing, vomiting or having diarrhea, please park at the green curb, wait in your vehicle and let us know when you arrive for your appointment.

Pre-sedation Form

Date of sedation procedure(Required)

Owner

Owner Name(Required)

First Last

Owner's Date of Birth(Required)

Phone(Required)

Opt-in for Text Updates?(Required)

Yes

Animal

Animal Name(Required)

History

Has your pet had a problem with sedation or anesthesia in the past?(Required)

Yes

Please describe(Required)

Does your pet have any history of seizures?(Required)

Yes

Currently being treated or on meds?(Required)

Yes

Has your pet had an adverse reaction to any medication?(Required)

Yes

Please describe(Required)

Does your pet have any medical problems?(Required)

Yes

Please describe(Required)

Has your pet had any previous surgeries?(Required)

Yes

Please describe(Required)

Is your pet currently taking any medication?(Required)

Yes

Please list(Required)

Have any pets in the home shown signs of illness in the last 7 days?(Required)

Yes

Please describe(Required)

Is your pet microchipped?(Required)

Yes

Would you like us to implant one during the visit?(Required)

Yes

For un-spayed females, when was the last heat cycle?

Emergency Contact

Name(Required)

First Last

Phone(Required)

Use links below to submit forms online

Grooming Click Here for Bubbles & Bows Salon

Boarding/ Day Care Click Here for Bed & Biscuit Inn

Owner

Animal

Owner

Animal

History

If your pet is coughing, sneezing, vomiting or having diarrhea, please park at the green curb, wait in your vehicle and let us know when you arrive for your appointment.

Owner

Animal

History

Emergency Contact

Site Links

Contact Info

LOCAL 24 HOUR EMERGENCY CARE

Business Hours