Cytopoint Pre Visit Questionnaire

Please take a few minutes to answer the questions below to help us gather some more information before you come in for your pet's appointment.

Your Name *

First

Last

Your Pet's Name *

When is your appointment with us? *

This examination and Cytopoint injection will be done by a Veterinary Technician unless you would prefer it to be done by a Veterinarian. *

*If you suspect that your pet may have an ear infection or skin infection, they must be seen by a doctor. **If you prefer that a doctor perform your pet's exam and injection, there is an additional exam fee of $17.

Do you have any concerns about your best friend? Please describe and for how long? *

Have you seen any scabby or irritated areas on your pet's skin? Have they been shaking their head or scratching at their ears? *

What medications do you give your pet? How much and how often?

What is the name of the food(s) your pet normally eats?

Any other procedures your pet needs done today?

Nail trim
Express anal glands (Dogs Only)

*Additional charges do apply.

Do you need refills on any of your pet's medications while you are here? Please list them below.

Our Values

Compassion | Family | Excellence | Integrity

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Our Values

Compassion | Family | Excellence | Integrity