Skip to content
Open Menu
(603) 433-5665
Get Directions
Make an Appointment
(603) 433-5665
Home
About
Our Story
Veterinarians
Team Members
Fear-Free Visits
AAHA Accredited
Careers
Services
Wellness Care
Vaccinations & Microchipping
Dental Care
Spay and Neuter
Surgery
Avian, Reptiles & Small Mammals
Diagnostics
Senior & End-of-Life-Care
Urgent Pet Care
Laser Therapy
Dermatology & Allergies
Transparent Pricing
Resources
Make an Appointment
Client Forms
FAQ
Exotic Pet Educational Resources
After-Hours Emergency
CareCorrals
Blog
Download Our App
Contact
Dogs/Cats: Pre-Appointment Check in Questions
Please provide at least 24 hours prior to appointment.
"
*
" indicates required fields
Step
1
of
3
33%
Name
This field is for validation purposes and should be left unchanged.
Name
*
First
Last
Email Address
*
Pet's Name
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
The information above is new and needs to be updated in Canobie Lake Veterinary Hospital's records.
Update records
Are you or any family member experiencing any signs of COVID-19 illness like fever, cough, body-aches, or loss of taste or smell?
*
Yes
No
Have you been exposed to anyone knowingly with COVID-19 illness in the last 14 days?
*
Yes
No
Note: Masks are now optional to wear on the day of your appointment.
Any concerns you want discussed with the doctor?
*
Is your pet...
Vomiting
Diarrhea
Coughing
Sneezing
Drinking more than usual
Peeing more than usual
What food/specific diet do you feed your pet?
*
What treats and snacks do you feed your pet?
*
Do you exercise your pet regularly?
*
Yes
No
Does your pet go outside?
*
Yes
No
When was the last time your pet was in another state or out of the country?
*
Is your pet in social setting (daycare, groomer, boarding, dog park, etc.)?
*
Yes
No
What medications/supplements is your pet on? (name, dose, frequency and last given):
*
Do you need any medication refilled? (name)
Is your pet currently on heartworm prevention? What kind?
*
Do you give heartworm prevention all year round?
*
Yes
No
Do you need heartworm prevention today?
*
Yes
No
Are you currently using flea/tick preventative? What kind?
*
Do you need flea/tick preventative today?
*
Yes
No
Does your pet have any behavior issues?
*
Yes
No
Do you brush your pet’s teeth?
*
Yes
No
Yes No Do your pet need a nail trim today?
*
Yes
No
Does your pet have a microchip?
*
Yes
No
Do we have permission to take photos of your pet and post on social media?
*
Yes
No
Do you have pet insurance?
*
Yes
No
Are you a Pet Rewards member?
*
Yes
No
If expired, do you want to renew?
*
Yes
No
Please bring in a fresh fecal sample with you to your appointment for all preventative care exams or if your pet is having a vomiting or diarrhea.
*
I understand
Do you have any other information that you think important and need us to know?
To use web better, please enable Javascript.