Patient Appointment Form 2 | Oakview Veterinary Medical Center in Plover, MI

We appreciate you taking the time to complete this form prior to your appointment. The completed questionnaire helps us to approach your pets exam in a more planned manor to promote a fear free, low stress experience for your pet while ensuring we answer all of your pet care questions and make a plan for their health care.

On arrival, please remain in your vehicle, and call the office to let the staff know you are here. The medical staff will let you know when they can escort your pet directly to a room. Thank you for helping us try to promote a more quiet, “fear-free” environment for our more shy and anxious patients.

Client's First Name(Required)

Client's Last Name(Required)

Pet's Name(Required)

Phone Number(Required)

Appointment Date(Required)

Appointment Time(Required)

AM/PM

What type of pet do you have?(Required)

Where was your rodent obtained from?(Required)

How long have you owned your rodent?(Required)

Please describe what you feed your rodent (how often and when), as well as any treats.(Required)

Is your rodent eating normally?(Required)

Yes

Is your rodent drinking normally?(Required)

Yes

Does your rodent's urine/stool look normal?(Required)

Yes

Is your rodent's activity level normal?(Required)

Yes

Please describe why your rodent is here today.(Required)

Please describe your rodent's enclosure. Including the cage type, size, substrate you use, and any environmental enrichment you provide for your rodent.(Required)

Where is your rodent's enclosure located in your home?(Required)

How often is your rodent handled?(Required)

Does your rodent have any cage mates? If so – please share how many.(Required)

Has your ferret been vaccinated for (check all that apply)(Required)

Rabies

Distemper

My ferret has not been vaccinated yet

Please let us know if your ferret has had any recent lab work, when it was, and what it was for.(Required)

Where was your ferret obtained from?(Required)

How long have you had your ferret?(Required)

Do you have any other ferrets in the household? If so – how many?(Required)

Please share what diet you are currently feeding your ferret, including any treats.(Required)

Please share what medications and/or supplements you are currently giving to your ferret.(Required)

Please describe your ferret's home, include the type of cage, size, bedding type and all environmental rich toys, and places to hide your ferret has.(Required)

How often is your ferret socialized?(Required)

If your ferret is sick, please describe the issue, and for how long.(Required)

Describe your ferret's attitude/activity level.(Required)

Is your ferret's appetite normal?(Required)

Yes

Where was your reptile obtained from?(Required)

How long have you had your reptile?(Required)

Please provide what type of food and feeding schedule of your reptile.(Required)

Is your reptile eating/drinking normally?(Required)

Yes

Is your reptile's urine/stool normal?(Required)

Yes

Is your reptile's activity level normal?(Required)

Yes

Please describe why your reptile is here today.(Required)

Please describe your reptile's enclosure, substrate, heat source, and temperature of the cage.(Required)

Please describe what environmental enrichment items you have for your reptile.(Required)

Where is your reptile's habitat located in the home?(Required)

(ex. bedroom, kitchen, living room…)

How often is your reptile handled?(Required)

Are there other reptiles in the cage with yours?(Required)

Yes

Who was your previous veterinary hospital?(Required)

Would you like any fecal testing?(Required)

Yes

How long have you had your rabbit?(Required)

Where was your rabbit obtained from?(Required)

How often is your rabbit handled?(Required)

What is your rabbit's current diet? Please include hay, pellets, and any treats you give.(Required)

Please list any and all medications and/or supplements your rabbit currently takes.(Required)

Please describe your rabbit's habitat, including cage type, size, and what type of bedding you use.(Required)

Is your rabbit kept indoors, outdoors or both?(Required)

Does your rabbit have any cage mates?(Required)

Yes

Please describe why your rabbit is here.(Required)

If your rabbit is sick, when did the issue start?(Required)

Is the issue progressing?(Required)

How has your rabbit's attitude been?(Required)

How is your rabbit's appetite?(Required)

Does your rabbit have diarrhea?(Required)

Yes

Where was the bird obtained from?(Required)

How long have you had your bird?(Required)

Are there any other birds in the house?(Required)

Please list all medication and/or supplements you currently give to your bird(Required)

Is your bird drinking normally?(Required)

Yes

Is your bird eating normally?(Required)

Yes

Does your bird's urine/stool look normal?(Required)

Yes

If your bird's urine/stool does not look normal, please describe.(Required)

What is your reason for today's visit?(Required)

Please describe your bird s enclosure.(Required)

Where is your bird located in the home?(Required)

(ex. living room, kitchen…)

What type of substrate do you use in your birds cage?(Required)

Please describe your bird's environment, and any sort of enrichment that you provide.(Required)

What is your bird's feather condition?(Required)

How often does your bird bathe?(Required)

Who was your previous vet?(Required)

Please use this comment section to include any questions or concerns you have. Please also include any information that you feel would be helpful in treating your pet today. We will do our best to have your pet seen and communicate a plan as quickly as possible.(Required)

We recommend arriving 10 minutes prior to the appointment. If you are scheduled for a routine, annual exam, we recommend yearly blood work and viral screening, fecals checked twice yearly, and vaccines due updated. We will provide an estimate of what we have in our records that is needed for your pet for you to review when we come to your car.

Please have your pet on the leash or in a carrier before we come to the car.

When you park, please call the office to let us know once you have arrived. To help us assist, please let us know the color, make, and model of your car.(Required)

(White Jeep Wrangler)

I authorize care of my pet by the veterinarians and staff of Oakview Veterinary Medical Center as described above and in accordance with their current policies. Changes or additions to this treatment plan will be discussed as needed, either in person or by phone communication, based on the veterinarian’s exam findings and subsequent recommendations. I understand this may involve my pet being accompanied by a staff member during their visit, rather than myself.(Required)

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