Please be advised patients will be greeted in our parking lot as our lobby remains closed. Please call us at 480-963-1815 when you arrive
"Veterinary care is an essential part of our community, and we want to assure you that our hospital is open and will continue to provide services at this time. We also want to work with you to limit direct contact in order to focus on safety for everyone during this pandemic. Accordingly, our lobby remains closed. We ask that you call from the car upon arrival to check in. A veterinary technician will discuss your pets care via phone call and escort you and your pet to a room once available. We kindly request clients wear a face covering while interacting with our staff. We have adjusted our current operations based upon the recommendations of the American Veterinary Health Medical Association, CDC and the World Organization for Animal Health. The following precautions are taken to protect you, our doctors and our staff from potential spread of Coronavirus COVID-19 while continuing to provide care. In an effort to streamline this service and be respectful of your time we would ask that you complete this history form before your visit. This will allow our team to be prepared to handle your pets concern as quickly and safely as possible. We truly appreciate your understanding and support during these uncertain times. Your Gilbert Veterinary Healthcare Team appreciates your support. "
Full Name
*
First Name
Last Name
Pet Name
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We would ask that if you are able, please wear a mask while handing your pet off to one of our team members.
Phone
*
-
Area Code
Phone Number
E-mail
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If you already have an appointment scheduled, what date and time is your appointment scheduled for? Please call the office to schedule if you have not already scheduled an appointment.
*
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Month
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Day
Year
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2
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Hour
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30
Minutes
AM
PM
AM/PM Option
Have you or anyone you have come into contact with been exposed to COVID or shown signs of sickness in the past 10 days?
*
Yes
No
Reason for visit
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Please list your concerns
Medications
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Please list your pets current medications and last dose given
Diet and amount fed
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Please list your pets current diet, amount and frequency fed.
Please list any additional services, medication or products needed.
*
To keep everyone safe and minimize exposure is there anything else that you are in need of while you are here for your visit? Although online pharmacies and our local stores carry many products we are seeing long waits, delayed shipping and unnecessary exposure. GVH carries and has available most pet medications and prescription diets for your convenience. .
Eating
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Normal
Increased
Decreased
Drinking
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Normal
Increased
Decreased
Vomiting/Diarrhea?
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Vomiting
Diarrhea
Both
Neither
Is your pet coughing/sneezing?
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Coughing
Sneezing
Both
Neither
Signature
Clear
Diarrhea
*
Yes
No
Eating
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Normal
Increased
Decreased
Sneezing
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Yes
No
Vomiting
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Yes
No
Drinking
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Normal
Increased
Decreased
Urination
*
Normal
Increased
Decreased
Coughing
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Yes
No
Stool
*
Normal
Soft
Diarrhea
Current Pain Level
*
(0) - No pain
(1) - May be in pain
(2) - Mild pain
(3) - Moderate pain
(4) - Significant pain
(5) - Severe pain
Submit
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