Pre-Appointment Check-in Form

Pre-Appointment Check-in Form

Pre-Appointment Check-in Form

Pre-Appointment Check-in Form

Pre-Appointment Check-in Form



Email *


Address Line 1

Address Line 2



Zip code

Date & time of CONFIRMED appointment *



Vehicle make & model *

Vehicle color *

Spouse or approved secondary owner's name​​​​​​​ *

Spouse or approved secondary owner's name​​​​​​​ *

Pet's Name​​​​​​​ *

Species *

If Other, please specify.

Breed​​​​​​​ *

Color​​​​​​​ *

Age/Date of Birth​​​​​​​ *

Sex *

Please list your pet's current medications and any refills needed today. (include drug name, dosage and frequency)

If appointment is for a sick pet, what is the concern?

Where is the affected area on the body (if applicable)

When did you first notice the issue?

Reason for today's visit *

Does your pet display any signs of fear, anxiety or aggression when they are in unfamiliar surroundings or with other pets or people? Knowing what to look for will help us provide better care for your pet. *

Payment in full is expected at the time of service. Please indicate the payment type you will use for this visit: *

If your pet needs a surgical or dental procedure, and you'd like to spread payments over a few months, please look into CareCredit or ScratchPay. Both companies offer no interest payment plans.

I authorize treatment and/or service for any animal I bring to Peavine Animal Hospital. I agree to pay for all charges at the time services are rendered for my pet(s). I certify that I am the primary owner of the pet listed in this form. I will inform Peavine Animal Hospital of any abnormal symptoms my pet may be having at the time of check-in at each appointment. I understand that the staff of Peavine Animal Hospital will put my pet’s health first and foremost and that in the incident a medical-related reaction or incident occurs, I do not hold Peavine Animal Hospital responsible. I have read and understood all the above provisions with Peavine Animal Hospital. *

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