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(727) 592-1816
petcare@communityanimalhospitals.com
5895 54TH AVE N, St. Petersburg, FL 33709
Community Animal Hospitals
St. Pete Pet Hospital | Dog & Cat Veterinarian
Pet Check-In Form
Appointment Request Form
About Us
Services
Emergency Pet Care
Vaccination Appointment
Contact
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Pet Check-In Form
Appointment Request Form
About Us
Services
Emergency Pet Care
Vaccination Appointment
Contact
Pet Check-In Form
Use this form if you already have an appointment.
If you
NEED TO MAKE AN APPOINTMENT
, click here.
APPOINTMENT CHECK IN
Please complete and submit this form BEFORE your appointment time, to ensure our staff is ready when your pet arrives.
Have you or anyone in your household been Exposed to, Diagnosed with or Under Quarantine for COVID 19?
Yes
No
NOTE: Please wear a surgical mask or cloth face covering when bringing your pet for treatment.
"CDC recommends wearing a cloth face covering in public settings."
I prefer to:
*
Medical Patients Please plan to drop off all medical patients and pick up later. Wellness Patients (Vaccinations Heartworm test etc.) We prefer that you wait on these patients, please confirm with receptionist or technician if drop off is necessary.
Drop off
Wait in Car
If we have questions for you, is TEXT OK?
*
YES
NO
Best Mobile Phone Number for Text
Your Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
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Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
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Maine
Maryland
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Montana
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
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Ohio
Oklahoma
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Email
*
Mobile Phone
*
Pet Name
*
Species
*
Dog
Cat
Breed
*
Color
*
Age
*
Gender / Fixed
*
Male
Female
Neutered Male
Spayed Female
Current diet, amount fed, & frequency
*
Last Veterinary Visit
*
Date Format: MM slash DD slash YYYY
Rabies Vaccine Current?
*
YES
NO
NOT SURE
Pet have known allergies? Please list, or state "N/A".
*
Eating normally?
*
YES
NO
NOT SURE
Drinking normally?
*
YES
NO
NOT SURE
Coughing?
*
YES
NO
NOT SURE
Sneezing?
*
YES
NO
NOT SURE
Currently on Heartworm Preventative?
YES
NO
NOT SURE
If "YES" to Heartworm, which brand?
Currently on Flea / Tick Preventative?
YES
NO
NOT SURE
If "YES" to Flea / Tick, which brand?
Other current meds.
Why Am I Here Today?
Arthritis (or showing signs of arthritis)
Please check all that apply.
Lagging behind on walks
Licking of the affected joint(s)
Limping / lameness
Pain or stiffness when getting up or down
Personality change (aggression when normally good-natured)
Reluctance to walk, climb stairs, jump or play.
Yelping when touched
Bladder / Urinary Tract
Please check all that apply.
Bloody urination
Crying out or whining while urinating
Inappropriate urination (accidents in the house)
Increased frequency of urination
Licking genitals
Offensive (strong) odor in urine
painful urination
Straining to urinate
Urgency of urination
Urine dribbling
Dental Disease
Please check all that apply.
Bad breath
Bleeding or red gums
Blood in water bowl or on chew toys
Bloody saliva
Bumps or lumps in the mouth
Drooling
Loose teeth
Painful
Problem picking up food
Refusing to eat
Yellow-brown tarter on teeth
Digestive Problems
Please check all that apply.
Blood or mucus in the stool
Constipation
Diarrhea
Excess gas or flatulance
Loss of appetite
Painful stomach area
Straining when passing stools
Vomiting
Ear
Please check all that apply.
Crusting or scabs in ear
Dark discharge from ear
Head shaking
Infection
Itchiness
Odor
Painful ear
Redness in the ear canal
Scratching at the affected ear
Swollen ear flap (HEMATOMA)
Eye
Please check all that apply.
Dilated pupils
Excessive blinking
Excessive tearing
Eye bulging
Eye cloudiness
Eye inflammation
Eye irritation
Eye pain
Eye redness
Gooey eye discharge
Inflammation around eye
Lump on eyelid
Pawing at the eyes
Squinting
Prescription Refill
Tell us what you need
Skin Disease
Please check all that apply.
Allergy
Allergic dermatitis
Bumps / Lumps
Hair loss
Hot spots
Infection
Itching
Masses / tumors
Skin, painful to the touch
Weight Change
Change in weight?
Vaccinations
Check applicable age.
Adult Dog (1-yr or older)
Puppy (select age range below)
Adult Cat (1-yr or older)
Kitten (select age range below)
Puppy Age (weeks)
How old is your puppy? (weeks)
Kitten Age (weeks)
How old is your kitten? (weeks)
Heartworm Test
Heartworm Preventative
Flea / Tick Preventative
Other, Not Listed
Other important issues to discuss today:
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Medical Record Upload
If necessary, please upload your pet's medical records.
Pet's Name
First
Last
Medical Record Upload
Please upload any necessary files. File types accepted are JPG and PDF. Phone camera photo is acceptable.
Drop files here or
Accepted file types: jpg, pdf.
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