Loyal Family Vet

"Improving the health and quality of life of every animal we touch"

Award Winning Family Veterinary Hospital

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Home
Our Team
Services
Pharmacy
Resources
- Pet Traveling
- AAHA
Client Forms
Policies
- Mutual Respect Policy
- Appointment Policy
Promotions
Join Us
Contact Us

Home
Our Team
Services
Pharmacy
Resources
- Pet Traveling
- AAHA
Client Forms
Policies
- Mutual Respect Policy
- Appointment Policy
Promotions
Join Us
Contact Us

Appointment Check-In

Appointment Check-In Form

Client Name (First and Last):

Email:

Phone:

Name of the person accompanying pet to the appointment:

Relation:

Self / Owner

Family Member

Friend

Pet Sitter / Dog Trainer

Does this person have authorization to approve diagnostics or treatments for the pet?:

Yes

No

If NO, who should we call? (name and phone number):

Free Text

For returning clients: Has your pet seen any other veterinarians / specialists since their last visit?:

Yes

No

New client / patient

If Yes, where can we call for records? (name and phone number):

Free Text

Pet's Name:

Primary Reason for Visit:

Any Allergies to Food or Medication?:

Yes

No

Unknown

If YES, to what and what was the reaction?:

Any Vaccine Reactions in the Past:

Yes

No

Unknown

If, YES what vaccine AND what was the reaction?:

Is your pet indoors, outdoors, both?:

Indoor

Outdoor

Both

Is your pet currently on any parasite prevention? (write the name of the prevention):

When was the last dose of parasite prevention given?:

Is your pet currently taking any medications?:

Is your pet currently taking any supplements?:

What food does your pet eat?:

type

Dry / Kibble

Canned

Both

Is this food grain free?:

Yes

No

How much are you feeding and how often?:

Does your pet get any other treats or snacks?:

How is your pet's appetite?:

Low

Normal

High

If abnormal, when did you notice a change?:

How is your pet's energy level?:

Low

Normal

High

If abnormal, when did you notice a change?:

Any Coughing, Sneezing, Vomiting or Diarrhea? (check all that apply):

Coughing

Sneezing

Vomiting

Diarrhea

None

If Yes to any, when did it start?:

Any change in water consumption?:

No Change / Normal

Yes, drinking less

Yes, drinking more

If Yes, when did you notice a change?:

Any change in urination amounts or habits?:

No Change / Normal

Yes, less than normal

Yes, more than normal

If Yes, when did you notice a change?:

Any changes to the skin or signs of itchiness?:

No Change / Normal

Itchy

Redness / irritation

Scabs

Loss of fur

Wounds / lacerations / bleeding

If abnormal, when did you notice a change?:

Any changes in your pet's mobility or signs of slowing down?

Any recent travel out of state or Eastern Washington?:

Yes

No

If Yes, when and where did your pet travel?:

Do you have pet insurance?: (company)

Free Text

Do you need any of the following? (check all that apply):

Refill of parasite prevention

Refill of medication

Bloodwork (if needed / recommended)

Update Vaccines (if any due)

Nail Trim

Anal Gland Expression

None

Free Text

Anything else we should know?

space

Authorization

By checking, I hereby certify that I am the owner or I am the responsible party of the named animal. I authorize the veterinarian at Loyal Family Veterinary Hospital to examine, prescribe for, and/or treat the above-described pet(s). I assume full responsibility for the payment for all veterinary services rendered.

Electronic Signature (type your full name)

Thank you for submitting your pet's appointmnet check-in form. We will reach out to you if we have any questions.

We look forward to seeing you soon!

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Now Offering Same Day Urgent Care Appointments

Appointments are required and are first come first served, pending availability. Please no walk-ins.

*Established Clients Only*

Seattle Met Top Vets horizontal text in grey and black block letters.

Five blue stars in a line with the text EnviroStarts in black and blue block letter written below.

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Link: Green circle with a outline of a dog and cat next to Pet Portal in black text.

Link: Red box with white lettering that says See current pet food / treat recalls.

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Loyal Family Veterinary Hospital

677 120th Ave NE, Suite 3A

Bellevue, WA 98005

Contact Us

Ph: 425-201-1908

Email: contact@loyalfamilyvet.com

Text: 425-207-4852

Business Hours

Monday - Friday: 7:30am - 6:00pm

Saturday: 9:00am - 4:00pm

2021 © All Rights Reserved | Loyal Family Veterinary Hospital

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