APPOINTMENT QUESTIONNAIRE

Sycamore Vet Hospital has made the difficult decision to do all appointments as curbside only until further notice. We hope you understand we are trying to do our part to help decrease the spread of COVID-19.

In order to expedite your upcoming visit with us it would be helpful if you could answer the following questions prior to your scheduled appointment.

Date
Date Format: MM slash DD slash YYYY
Client Name*
First Last
Pet's Name*
Phone*
(Please make sure this is a number that the Doctor can reach you on while your pet is in the building with us)
Food Type
What brand of food are you feeding?*
How much?*
How often?*
Heartworm Medication
What Heartworm Preventative do you use?*
If other, please specify.
What Day of the month is it given?
Do you need more?
If yes, how many doses?
Flea/Tick Medication
What Flea/Tick Medication do you use?*
If other, please specify.
What Day of the month is it given?
Do you need more?
If yes, how many doses?
Additional Information
(Feline Only) Is your pet strictly indoor?
If no, how often do they go outside?
Do you use any boarding, grooming, or daycare services?
If yes, where?
Are there any special concerns we should be aware of?
Examples would be a lameness, lumps, ear or skin issues, changes in behavior, appetite or water consumption.
If yes, please explain.
Do you need a refill on any other medications while you are here?
If yes, please list.

APPOINTMENT QUESTIONNAIRE

Food Type

Heartworm Medication

Flea/Tick Medication

Additional Information