Patient History Form

Name: Chinook Pet Clinic
Address: 487 41 St S, Lethbridge, AB, T1J 5C8, CA
Telephone: (403) 327-2344

Please fill out our Patient History Form below prior to your pet's appointment at Chinook Pet Clinic.

Patient History Form

Name: *

Pet's Name: *

Phone: *

Email Address: *

1. Is the person filling out this form going to be present during the appointment? *

Yes

If no, will they be available to contact during the appointment?

Yes

Phone number to contact during the appointment: *

If no, you must call us before the appointment at (403) 327-2344

2. Do you have pet insurance for your pet? *

Yes

3. If no, are you interested in more information about pet insurance?

Yes

4. What is the lifestyle of your pet? (fill in the blanks below)

Dogs: City or Farm? Describe their lifestyle below:

Do they go camping, hiking, or swimming? *

Yes

Cats: Indoor, outdoor or both? Describe their lifestyle below:

5. Are there other pets in the home? Please specify species: *

6. Do you travel with your pet outside of Alberta? Please specify where. *

7. What food is your pet eating (including treats)? Please specify brand, formula: (ex: puppy, adult, sport, senior, homemade, raw etc.) *

8. Is the food grain free? *

Yes

How much are they eating? (ex: ½ cup twice daily) *

9. Is your pet on any medications, supplements, or over the counter treatments? (including monthly parasite treatments or injections). Please specify name, dose, and frequency. *

10. Do you need refills of a medication? *

Yes

If so, what medication including dosage? How often are you giving it? Amount you would like filled?

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Welcoming New Patients in Lethbridge

We have served Lethbridge for more than 60 years, working tirelessly to deliver compassionate veterinary care to our community's beloved cats and dogs. We'd love to meet you and your furry friend!