Canine Check-In Form

Thank you for scheduling an appointment with GPVC. Please complete the form below prior to your arrival so we may have as much information as possible to prepare for your dog’s visit. Once you arrive in our parking lot please call 503-245-7275. We will meet you curbside to bring your dog in for his/her exam. Please ensure their collar is secure and a leash is attached. We will be in touch very shortly to discuss our exam findings and your concerns.

We thank you for your patience and trust during these unprecedented times. We want to do everything possible to keep us all safe while continuing to provide veterinary care to our beloved patients. If you have any concerns or questions about your visit with us, please do not hesitate to contact us.

Required fields are marked(*)

Your full name:*
First Last
Your dog's name:*
Your email:*
Your phone # for TODAY'S communication:*
Canine Wellness Check in Sheet:
How would you describe your dog’s health since we last saw him/her?
- Excellent
- Very Good
- Good
- Fair
- Poor
Describe any abnormal behavior or symptoms your dog is exhibiting.
What food are you feeding your dog?
Describe any changes in your dog’s water consumption.
Describe any known allergies.
What medications is your dog currently receiving? (please include supplements)
What is the dose and frequency of all medications?
When was the medication last given?
Describe what type of exercise your dog has and the frequency of the exercise.
Is your dog on heartworm prevention?
- Yes
- No
If yes above, what preventive is he/she receiving and with what frequency?
Is your dog on flea/tick prevention?
- Yes
- No
If yes above, what preventive is he/she receiving and with what frequency?
What information/concerns would you like to discuss with the DVM/Technician during today’s visit?
Do you need refills of medications during your visit today? If so, please list below with the current dosing.
Do you need to purchase food? Please provide type and amount.
Please provide any additional information you would like us to know for our time with your pet today.
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Canine Check-In Form

Canine Wellness Check in Sheet:

503-245-7275

HOSPITAL AFFILIATIONS: