Test - Trenton Pet Hospital

Your Contact Information

Name*

First Last

Spouse/Co-Owner Name

First Last

Address*

Street Address City Postal Code

Email*

Cell Phone

Co-Owner Cell Phone

Home Phone

Are you looking to book an appointment?*

Yes
No

Appointment availability, types and lengths vary. Please list a few dates/times that may work best for you.

If you are looking to book an appointment, please tell us what you would like to book your pet for:

Name of Previous Clinic (if no previous clinic, type N/A)*

How Did You Hear About Us?*

Your Pet's Medical Information

Pet's Name

My pet is a

Dog
Cat
Other (Pocket Pet or Bird)

Breed

Colour

Is your pet microchipped?

Pet's Date of Birth

Sex

Male
Female

Spayed/Neutered?*

Yes
No
Unknown
Is going to be used for breeding

Does your pet have any chronic medical conditions?

If yes, please describe:

Does your pet have any allergies?

If yes, please describe:

Fear Free Questions

How would you describe your pet's reaction going to the veterinary hospital?*

Does your pet show reluctance to getting in a pet carrier or vehicle?*

Yes
No

How does your pet travel when in a vehicle?*

How does your pet behave in the vehicle?*

Vocal/Barking/Whining
Restless/Pacing
Panting
Drooling
Trembling
Perfectly

Are there things you or your pet did not like during past veterinary visits?*

Being weighed
Getting on the exam table
Having a procedure done
Being handled
Walking through the clinic
Other

How would you describe your pet around other animals and people?

Has your pet ever been prescribed any medication to help with previous veterinary visits?*

Yes
No

Do you have any other pets you would like to add?

Yes
No

2nd Pet's Name

My 2nd pet is a

Dog
Cat

2nd Pet Breed

Colour

Is your 2nd pet microchipped?

Yes
No
Not sure

2nd Pet's Date of Birth

2nd Pet's Sex

Male
Female

Spayed/Neutered?

Yes
No
Unknown
Is going to be used for breeding

Does your 2nd pet have any chronic medical conditions?

If yes, please describe:

Does your 2nd pet have any allergies?

If yes, please describe:

Fear Free Questions

How would you describe your pet's reaction going to the veterinary hospital?*

Does your pet show reluctance to getting into a pet carrier or vehicle?*

How does your 2nd pet travel when in a vehicle?*

How does your second pet behave in a vehicle?*

Vocal/barking/whining
Restless/pacing
Panting
Drooling
Trembling

Are there things you or your pet did not like during past veterinary visits?*

Being weighed
Getting on the exam table
Having a procedure done
Being handled
Walking through the clinic
Other

How would you describe your pet around other animals and people?

Has your pet ever been prescribed any medication to help with previous veterinary visits?*

Yes
No

Do you have a third pet you will like to add?

Yes
No

3rd Pet's name

My 3rd pet is a

Dog
Cat

Breed of 3rd Pet

Colour

Is your 3rd pet microchipped?

Yes
No
Not sure

3rd Pet's Date of Birth

3rd Pet's Sex

Male
Female

Spayed/Neutered?

Yes
No
Unknown
Is going to be used for breeding

Does your 3rd pet have any allergies?

If yes, please describe:

Does your 3rd pet have any chronic medical conditions?

FEAR FREE QUESTIONS FOR 3rd PET

How would you describe your pet's reaction going to the veterinary hospital?*

Does your pet show reluctance to getting into a pet carrier or vehicle?*

Yes
No

How does your third pet behave in a vehicle?*

Vocal/barking/whining
Restless/pacing
Panting
Drooling
Trembling

Are there things you or your pet did not like during past veterinary visits?*

Being weighed
Getting on the exam table
Having a procedure done
Being handled
Walking through the clinic
Other

How would you describe your pet around other animals and people?

Has your pet ever been prescribed any medication to help with previous veterinary visits?*

Yes
No

Consent & Agreement

Photo/Video Consent*

Yes, I consent
No, I do not consent

Occasionally, we take videos and pictures of our pets to post on social media and use for training, do you consent to our use of photos/videos of your pet? Please follow our social media accounts!

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.*

I have read and understand.

I/we have read, understood and agree to abide by Trenton Pet Hospital's Civility Policy*

I have read and understand.

Team members of Trenton Pet Hospital will treat each other and members of the public with respect. The same treatment is expected in return.

This policy is intended to promote mutual respect, civility and orderly conduct among clinic team members and the public. This policy is not intended to deprive any person of his or her right to freedom of expression, but only to maintain a safe, harassment-free workplace. TPH seeks public cooperation with this endeavor.

Aggressive or abusive behaviour, whether verbal or written will result in the termination of services.

Type Signature*

Let’s Connect

Contact Details

Get in Touch

Your Contact Information

Your Pet's Medical Information

Fear Free Questions

Fear Free Questions

FEAR FREE QUESTIONS FOR 3rd PET

Consent & Agreement

Address

Business Hours

Contact Info