Curbside Care Form – Campus Estates Animal Hospital

Call Us @ 519-837-1212
COVID-19 Practice Updates

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Curbside Care: Medical History Form

During the COVID-19 Pandemic, our practice is moving to “curbside care” to limit physical contact and adhere to social distancing recommendations. These new procedures help to limit exposure, not only to pet owners, but also to our veterinary team.

Please call the office to schedule an appointment for your pet.

In order for your veterinary healthcare team to provide comprehensive care for your pet, please fill in this form and return via email prior to your visit.

Date:*
dd/mm/yyyy
Owner's Name
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Pet Information
Pet's Name*
Species*
if other please specify
Breed (if known)
Sex
Color
Date of Birth or Age (if known)
Pet Health - Reason for Visit
Describe your concern*
How long has this been going on?*
Days/Weeks/Months
What are you currently feeding the pet?*
food/treats
How is their appetitie?*
poor/good/excellent
Are you currently giving any medications or supplements?*
- yes
- no
Please specify*
name/dose/last given
Any coughing or sneezing?*
- yes
- no
Please describe*
Any vomiting or diarrhea?*
- yes
- no
Please describe*
Have they gotten into anything? Eaten anything unusual?*
- yes
- no
Please describe*
Is your pet indoors only? (Cats)
Any environmental changes?*
Describe their behavior*
lethargic/normal/hyperactive
Any changes to thirst?*
increased/normal/decreased
Any changes to urination?*
increased/normal/decreased
How are their bowel movements?*
normal/abnormal
When was their last bowel movement*

For appointments please call 519-837-1212 Make an Appointment

About Us

We are committed to providing the highest quality of medicine within a warm and compassionate family atmosphere. We cater to the needs of our patients with a gentle hand.

Learn More

Regular Clinic Hours

Monday: 8:00am - 7:00pm
Tuesday: 8:00am - 7:00pm
Wednesday: 8:00am - 7:00pm
Thursday: 8:00am - 7:00pm
Friday: 8:00am - 6:00pm
Saturday: 9:00am - 4:00pm
Sunday: 1:00pm - 5:00pm

Location

Campus Estates Animal Hospital

1460 Gordon Street South
Guelph, ON N1L 1C8

Phone: 519-837-1212
After Hours Emergency: 519-837-1214
Fax: 519-837-0209

Directions

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Home
About Us
Services
Resources
Emergency
- Emergency Procedures
Links
Blog