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253-588-1851
253-201-6645
Online Pharmacy
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COVID-19 Updates
Today:
8:00 am - 6:00 pm
Open Hours
253-588-1851
Phone Number
11419 Bridgeport Way SW
Lakewood, WA, 98499
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Patient History Form
Fill out the fields below to share your pet’s history.
Your Name
*
Your Phone
*
Your Email
*
Patient Name
*
Appointment Date
*
Appointment Time
*
Which provider are you scheduled to see?
*
Primary Reason For Appointment
*
Patient Energy Level
*
Decreased
Normal
Increased
Is this patient on heartworm prevention?
*
Yes
No
Unsure
Please list all medications and if you need refills.
*
What type of brand food does your pet eat?
Patient Skin Health
*
Normal
Itchy
Has Rash
Losing Hair
Has Odor
Other
Patient Appetite
*
Decreased
Normal
Increased
Patient Water Intake
*
Decreased
Normal
Increased
Is the patient coughing?
*
Yes
No
Unsure
Is the patient sneezing?
*
Yes
No
Unsure
Is the patient vomiting?
*
Yes
No
Unsure
Does the patient have diarrhea?
*
Yes
No
Unsure
Patient Urination
Decreased
Normal
Increased
Dark
Blood Present
Cloudy
Strong/Foul Odor
Straining to urinate
Other
Any other patient history we should be aware of?
Any other patient information the vet should be aware of?
A. Have you or anyone in your household tested positive for Covid-19 in the last 14 days or been exposed to someone who has?
*
B. Have you experienced unexplained coughing, fever, aching, loss of sense of smell or taste, and/or sore throat, in the past 14 days?
*
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