Exotics/Birds Only: Pre-Appointment Check in Questions

URL

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

Are you a Pet Rewards member?*

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

What food/specific diet do you feed your pet?*

List any medications/supplements your pet is on (name, dose, frequency and last given):

Do you need any medication refilled? (name)

What type of enclosure do you have for your pet, including lights, heat, etc, if applicable? **

Does your pet have any behavior issues?*

Yes

No

If your pet has nails, does it need a nail trim?*

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

Do you have any other information that you think important and need us to know?