Have you or anyone that you have had close contact with tested positive for COVID-19 in the past 14 days?*

Have you or anyone in your house experienced the following symptoms in the past 14 days?*

*If you are ill or have been exposed to someone who is ill, we request that a family member or friend bring your pet to their appointment.

Best phone number(s) to contact you for today’s visit (this should be the person making decisions for treatment and financial decisions):

Is someone else bringing in the pet for the appointment and what is their phone number:

Patient's Name*

Patient's Species

Email Address*

Primary reason for your visit today (please list all concerns you may have and be detailed including how long the problem has been going on):*

Has your pet been treated for this condition before and was there a response to treatment (include treatments or medications that have been used):

Does your pet come into contact with other dogs? Please check all that apply*

Do you need any refills of these medications?

Which medications?

What brand of pet food does your pet eat? (please specify if it is wet or dry or both, amount and frequency) Again this is important for us to know ahead of time:

Do you feed your pet any treats, table scraps and has there been a recent change in their diet or treats:

When was the last dose given?

Patient's Energy Level

Patient's Appetite

Drinking and water intake

Urination habits (for cats - does the patient ever urinate outside the litter box)

Please check any that apply

If you are visiting us for the first time or have been to another veterinary hospital, please have the records emailed to redwood_info@yahoo.com. It is very important that we have these records before your appointment as we may need to reschedule if they are not available.