Grandview Animal Hospital Canine MEDICAL visit

Grandview Animal Hospital
Canine MEDICAL CONCERN visit
You are receiving this form in advance of your pet's appointment at Grandview Animal Hospital. At this time we are operating fully curbside and only employees are entering the building. Our exam rooms do not allow for safe social distancing and curbside service allows us to continue serving our clients and patients safely. This model of service continues to evolve as we work to improve efficiency and we are grateful for your patience.
Your pet will be brought inside during the check in process and we will work diligently to keep you informed and updated throughout the visit. You will be able to speak with the doctor and will be provided detailed written exam findings and discharge instructions. Feel free to communicate questions or concerns prior to your visit.
Date of Appointment
MonthDayYear
Date
Your Name
Your Pet’s Name
Please budget ONE HOUR for this visit. You are welcome to wait or return at your convenience. We are happy to work around your schedule if possible. Sick pets may be admitted for additional testing or treatment and picked up at the end of the day. Please provide the phone number we can use DURING the visit to contact you with questions or updates.
Area CodePhone Number
Please drive to the back of the clinic and call 816-761-5071 to let us know you have arrived. Bring your dog on a leash or in a carrier inside the gated area. A staff member will come outside for check in. If there are other clients or patients in the fenced area you can wait for a team member. Please let us know if we can better accommodate you or your dog during the visit.
My dog has limited mobility and needs to avoid stairsI will need assistance getting my dog in or out of the vehicleOther
Current medications or supplements and doses:
What are you currently feeding your dog? Is this a recent change?
What is the main reason for your visit today? What questions or concerns do you have for the doctor? Include information you feel may have contributed to the problem.
Is this a new concern or a chronic problem that has been treated before?
New problem, the first time we have seen these symptomsHas happened before but not recentlyFlare up of chronic problem that we treat regularlyChronic problem that has not improvedOther
I have noticed:
Loss of mobility, lameness, limping or discomfortLumps or bumps on or under the skinUrine or stool accidents or changes in toileting habitsVomitingDiarrheaBad breath or changes with teeth / gumsIncreased water intakePoor appetiteWeight GAINWeight LOSSRash or ItchingLoss of vision or abnormal appearance of eyesCoughing or difficult breathingOther
Are there images or videos that would be helpful for todays visit?
Browse Files
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How can we help? Medication refill, Food refill, Other?
Would you like an estimate for the services due? We can finalize the estimate and make payment arrangements in advance to expedite your visit.
Please contact me to discuss and approve estimateMy payment information has been saved at a previous visitI will utilize Care Credit for this visitOther
Should be Empty: