• Curbside History Form

    Please have this form complete before coming to the hospital. Your pet will be brought into the hospital by a team member, the doctor will do an exam and any questions/conversations will be by phone. Please have a cell phone ready and the number of that phone on this form. Payment for services will be curbside as well and expected after the visit is complete.

  • Due to the COVID-19 prevalence, we want to ensure your safety and that of our team. Please answer yes/no to these questions:

  • Do you, or someone in your household, have symptoms consistent with COVID-19, a fever, cough or difficulty breathing?*
  • Have you, or someone in your household, been exposed to someone who has tested positive for COVID-19?*
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  • Appointment Date*
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    2 digit month, 2 digit day, 4 digit year
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  • Has your pet been coughing?*
  • Has your pet been sneezing?*
  • Does your pet have nasal discharge?*
  • Has your pet been vomiting?*
  • Has your pet had diarrhea?*
  • Does your pet's stool look normal color?*
  • Has your pet been drinking more?*
  • Has your pet been urinating more?*
  • Have you seen your pet's urine?*
  • Has your pet's appetite changed?*
  • Any change in diet?*
  • Is your pet lethargic?*
  • Is your pet here because it is limping? If so, which leg and how long?*
  • Has your pet cried out?*
  • Does your pet have problems with one or both of their eyes?*
  • Does your pet have problems with one or both of its ears?*
  • Do you have concerns with your pet’s teeth?*
  • Would you like your pet’s nails trimmed while here?*
  • Would you like your pet’s anal glands emptied?*
  • Are there any new lumps or bumps you have found?*
  • We are now offering Simparica Trio, an all-in-one heartworm, intestinal parasite, flea,and tick preventative.  Would you be interested in learning more about Simparica Trio?*

  • Curbside appointments must arrive 10 minutes prior to 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 are needed for your pet for your review when we come to your car.

     

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

  • I authorize curbside service and care of my pet by the veterinarians and staff of Bartlett Animal Hospital. I understand this may involve my pet being accompanied by a staff member during their visit,rather than myself. I understand that staff members will be handling my pet;they may be approaching and/or partially entering my vehicle or meeting me at the clinic door. Further medical authorization of recommended treatment(s) will be done via phone communication; I consent to over the phone financial and treatment authorization. 
  • Should be Empty: