Appointment History Questionnaire

Appointment History Questionnaire

Please complete this form to the best of your ability to save time during your appointment. Thank you!

Client Information

Please include First and Last Name
Do you already have an appointment scheduled for your pet?

Please call us to schedule your appointment (616-531-7387). This form is for pre-appointment history and concerns only, not appointment requests. We look forward to your call!

Are you the person bringing your pet to the appointment?

Please provide the name and phone number of the person who will be at the appointment:

Is this person authorized to make financial or medical decisions for you or your pet?

Patient Information

If you are bringing more than one pet, please fill out one form for each pet.
Has this pet been seen at Animal Medical Center before?
Species
Enter unknown if not sure

Previous Medical History

Do you have previous veterinary records, adoption paperwork, breeder paperwork, etc.?
Maximum upload size: 10MB
Please upload previous medical history, vaccination records, adoption paperwork, etc. You can upload multiple files if needed. If you are unable to upload, please skip and bring all paperwork/history to your appointment.
Is there a previous veterinary hospital we can contact for a copy of medical records?
Please provide us with as much information as possible about your pet’s previous veterinarian so we may contact them for previous medical history.

Previous Veterinary Hospital

Please provide the owner and/or pet name on file if different than what you provided above.