Curbside Care Patient History – Watertown Animal Hospital

Curbside Medical History Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. Please complete this from as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Name of Person Bringing to Appointment
Name*
First Last
Are you ill or have you been around anyone who is sick in the last 14 days?*
- Cough
- Fever
- Chills
- Sore Throat
- Head Ache
- Muscle Aches
- Been Around Someone Who is Sick
- Lost you sense of taste
- None of the Above
Best Contact # During Appointment & Email for Receipt
Cell Phone*
Email*
Enter Email Confirm Email
Patient Information
Pet's Name*
Describe your concern or reason for the appointment*
How long has it been going on?*
- Days
- Weeks
- Months
- N/A
What food and treats are you currently feeding your pet?*
How is their appetite?*
- Poor
- Good
- Excellent
When did they eat last?*
Are you currently giving any medications or supplements?*
- Yes
- No
If so: Name/Dose/Last Given
Any coughing or sneezing? If so, please describe:*
Any vomiting or diarrhea? If so, please describe:*
Have they gotten into anything? Eaten anything unusual?*
Is your pet indoors only?*
- Yes
- No
Any environmental changes?*
How is their behavior?*
- Lethargic
- Normal
- Hyperactive
Any changes in thirst?*
- Increased
- Normal
- Decreased
Any changes in urination?*
- Increased
- Normal
- Decreased
How are the bowel movements?*
- Normal
- Abnormal
When was their last bowel movement?*
Does your pet have allergies or drug reactions?*
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions we should be aware of?*
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet

Emergency Process

PLEASE CALL BEFORE GOING
We refer our emergencies after hours, based on your location to:

Angell at 350 South Huntington Ave in Jamaica Plain at 617-522-7282

Blue Pearl at 180 Bear Hill Rd in Waltham at 781-684-8387

Blue Pearl at 56 Roland St in Charlestown at 617-284-9777

Boston West at 5 Strathmore Rd in Natick at 508-319-2117

Massachusetts Veterinary Referral Hospital at 20 Cabot Rd in Woburn at 781-932-5802

Veterinary Emergency Group at 165 Needham St in Newton at 617-729-4446

Veterinary Emergency Group at 312-316 Stuart St in Boston at 617-762-0001

Veterinary Emergency Group at 357-359 Fresh Pond Pkwy in Cambridge at 617-804-0103

WE REFER URGENT CARE TO:

Angell West Urgent Care at 293 2nd Ave in Waltham at 781-902-8400

PetMedic Urgent Care at 109 First St #101 in Cambridge at 617-209-6003

PetMedic Urgent Care at 112 Burlington Mall Rd in Burlington at 781-205-1097

PetMedic Urgent Care at 240 Andover St Unit G in Peabody at 978-806-2962

Veterinary Urgent Care-Station Landing at 25 Revere Beach Parkway Station Landing Plaza in Medford at 781-625-5959

Curbside Medical History Form

Name of Person Bringing to Appointment

Best Contact # During Appointment & Email for Receipt

Patient Information

Contact Us

Hours of Operation

Emergency Process