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About
Our Practice
Our Veterinarians
Our Care Team
Hospital Tour
Services
Wellness and Vaccinations
Diagnostics
Pain Management
Surgery
Dentistry
Behavioral Counseling
Allergy & Dermatology
Pocket Pets
Resources
Pet Portal
Curbside Form
New Client Form
Boarding Registration
Request a Refill
Downloadable Forms
Links
Pet Memorial
Online Store
Vetsource
Purina Pro Plan
Contact & Hours
Book Appointment
CALL (503) 645-1564
Curbside Form
Date
*
Date Format: MM slash DD slash YYYY
Pet Name:
*
Client Name:
*
Contact # during today's visit:
*
Vehicle Description
*
Reason for today's visit:
Other problems/concerns:
IF your pet is receiving vaccines today, would you like them to receive a dose of Benadryl? (Given to decrease effects of a possible vaccine reaction if patient were to have one)
Yes
No -Decline
Given at home prior to visit today
Diet Currently Feeding:
Grain Free?
Yes
No
Please List ALL Medications & Flea/Heartworm Prevention your pet takes:
Do you need any medication/food refills today?
Yes
No
Please list any refills needed
While my pet is here I approve any of the following recommendation that may be suggested by the veterinarian to treat/diagnose my pet
X-rays
Ear Cytology
Ear Cleaning / Flush
Fine Needle Aspiration of lump
Subcutaneous Fluids
Urinalysis / Cystocentesis sterile urine collection)
Skin Cytology / Scraping
Recommended Bloodwork
Heartworm Test (Recommended Annually by the American Heartworm Association)
Anal Gland Expression
Nail Trim
Anything Necessary
Nothing - Call 1st to discus (understand it may slow down the process)
Select all that apply
COVID-19 History:
I have been experiencing cold/flu symptoms.
I have traveled out of the state of country in the last 30 days.
I have been exposed to COVID-19 or someone with it.
None of the above.
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