Curbside Form - Cornell Center Animal Hospital

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About
Services
Resources
Contact & Hours
New Client Form
Book Appointment

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Cornell Center Animal Hospital Lobby

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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