Follow-Up/Recheck Questionnaire
Please fill out this form to the best of your ability prior to your appointment. If you have any questions or concerns prior to your appointment please contact our office at (315)673-4858 or via email at contact@lcvetcare.com.
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Date *
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Client Name *
Patient Name *
Reminder: We are continuing to operate curbside. As a result, we will have you wait outside in your vehicle while your patient is taken inside the building for examination. Once the doctor has completed their exam, they will call you from inside the building to discuss. Please provide the number you wish us to use on the day of your appointment.
Phone Number *
When was your pet's initial visit with the doctor for this issue? *
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How has your pet been doing since its last visit? *
Have you noticed any new clinical signs since your last appointment? *
If yes, what clinical signs have you been seeing?
What medications is your pet currently taking? Please specify name, dose, and when the medication was last given. *
If your pet is here for diagnostics (x-rays, blood work, ultrasound) - when was the last time they ate? When did they last urinate?
Do you have any additional questions or concerns that you would like the doctor to address?
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