Pre-Appointment Form

Location

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Full Name *

Phone Number*

Last Name on File (if different from above)

Pet's Name *

Consent: I understand that I must have my pet on a securely tightened collar/harness and leash (not extendable leashes if possible please) or in a secure carrier*

Consent: I will inform the staff if my pet has special needs. It is helpful for us to know if your pet is aggressive with other pets or humans. If your pet is fearful or anxious, we may be able to provide some anxiety medications in advance for you to give 1-2 hours before the appointment*

Consent: I understand that it is recommended for me to bring a fresh stool sample in case it is needed*

Consent: I understand that it is recommended for me to bring a fresh urine sample if my pet has any increased drinking, change in urination habits*

Consent: I consent to my pet's photos being used for social media purposes*

What diet is your pet being fed (Brand, Type, flavour)?

How much pet food does your pet get per day exactly (# cups)?

Please list as precisely as possible all other treats, chews, table food that your pet gets in a day including amounts

Please list any medications or supplements that your pet is taking (including strength, and frequency)

Has your pet been to another facility from which we should request records to complete his/her file?

Does your pet travel outside of Kitchener (i.e. cottage)? If YES, where?

Does your pet spend time outdoors, please describe where

How much exercise does your pet get?

Has your pet had any vomiting? If YES, please describe (frequency, appearance etc)

Has your pet had any diarrhea? If YES, please describe (frequency, appearance etc)

Has your pet had coughing or sneezing or difficulty breathing?

Does your pet have any mobility concerns (difficulty with stairs, getting onto bed, getting into car)?

Does your pet have any lumps/bumps that you would like the doctor to assess? If YES, please list their locations, size and how long they have been present

Please list any other health concerns you have with your pet

Be Kind Policy

At our clinic, we prioritize creating a safe and compassionate space for all – clients, patients, and team members alike. Our Be Kind Policy underscores our commitment to respect and empathy in every interaction.

We have a strict no-tolerance stance towards any form of abuse, whether verbal, physical, or emotional. Such behavior will result in service refusal and client termination.

Our staff is dedicated to the well-being of your pets, and we believe that mutual respect and understanding are essential for a positive experience. Thank you for helping us maintain a supportive and caring atmosphere.

I have read and understand the "Be Kind Policy" *

Please don’t hesitate to call if you have any questions or concerns prior to your appointment. If you are unable to make your appointment, please give us 24 hours notice to cancel or reschedule so that we can accommodate another patient in your place.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Pre-Appointment Form

Be Kind Policy

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