Online Check-in in Bridgton, ME | Bridgton Veterinary Hospital

Patient History

To expedite your curbside check-in for your pets appointment please complete and submit for each pet. This can be done up to 72 hours ahead of your appointment time. If you have any questions please call us ahead of time at (207) 647-8804 as this form will not be reviewed until you arrive for your appointment. Thank You.

Name*
First Last
Email
Pet's Name*
Phone Number*
Appointment Date*
MM slash DD slash YYYY
Appointment Time*
: Hours
Minutes
AM/PM
What is your pet's visit for?
What type / brand of food does your pet eat and how much per day?
Current Medications / Supplements your pet is taking?
Is your pet currently on any Flea, Tick or Heartworm Preventatives?
Does your pet have any medical concerns today?*
Please check anything that your pet has experienced in the last week.
- Vomiting
- Diarrhea
- Painful
- Not eating or eating very little
- Drinking water more or less than normal
Any history of vaccine reactions? If yes, please list.
Is there any itching/skin concerns? If yes, please list.
Any growths that you are aware of? If yes, list location(s).
Any runny nose/runny eyes/coughing/sneezing?
- Yes
- No
Are there any other pets in the household, if so what?
Are you doing any home dental care?
- Yes
- No
Please list any other information the doctor needs to know or any other questions you may have.
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