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Some online services, including appointment reminders and online booking, may be temporarily unavailable. Please call us at (330) 467-6400 if you need assistance.

Canine History Form

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Canine History Form

URL

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Phone(Required)

Email(Required)

Pet's Name(Required)

Is you pet taking any medication?(Required)

Yes

Please list medications name, dosage/strength, and frequency(Required)

Is your pet on any parasite preventatives?(Required)

Yes

Name of Parasite Prevention(Required)

When did you administer their last dose?(Required)

Is your pet taking any supplements?(Required)

Yes

Please list supplement name, dosage/strength, and frequency(Required)

Has you pet had any previous vaccine reactions?(Required)

Yes

Please explain below

Is anyone in the immediate household considered to be immunocompromised (this may change our vaccine and parasite recommendations)?(Required)

Yes

Would you like our team to wear masks at the time of your appointment?

Yes

Does your pet go to any of the following facilities (please check all that apply):(Required)

Boarding

Grooming

Daycare

None of the above

Current Diet Brand(Required)

Current Diet Amount(Required)

Is your pet eating normally?

Yes

Please explain:

Does your pet any of the following symptoms? (please check all that apply):(Required)

Vomiting

Diarrhea

Coughing

Sneezing

Itching

Scratching

Increased Drinking

Increased Urinations

None of the above

Please explain (i.e. frequency, duration, etc.)(Required)

Has your pet ever had seizures?(Required)

Yes

When was your pet's last seizure?(Required)

Do you have any concerns about your pet's behavior?(Required)

Yes

Please explain:(Required)

Do you have any concerns about your pet's mobility or pain level?(Required)

Yes

Please explain:(Required)

Do you have any additional concerns about your pet or your appointment that you would like the doctor or team to know about?(Required)

Yes

Please explain:(Required)

Make an appointment!

We proudly server the communities of Northfield, Macedonia, Bedford, Walton Hills, Sagamore Hills, and Twinsburg. Click the button below to schedule an appointment online!

Appointment

Have a question?

Get in touch! Complete our online form and we will be in touch with you shortly.



Address

10446 Northfield Road,
Northfield, OH 44067



Contact

E: Pets@northfieldvethosp.com
P: 330-467-6400
T: 330-403-6485



Hours

Mon – Fri: 8:00 am – 6:00 pm
Sat: 8:00 am – 2:00 pm
Sun: Closed

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🚧 We’re Upgrading Our Hospital Software

Canine History Form

Canine History Form

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