Roncesvalles Animal Hospital

Menu

Intake Questions with a DOCTOR

Home > Intake Questions with Doctor Form

We are requesting that you complete these questions prior to your DOCTOR visit with us. This will help make your pet's appointment go smoothly.If your appointment is with a Technician, use the other form.

You understand this is a DOCTOR appointment form(Required)

Name(Required)
Email Address of Pet Owner(Required)
Are you the individual responsible for decisions and accounts for this pet?(Required)
This individual should be the owner on the account file, responsible for decisions and payments and of legal age (18+) .
Is this a second opinion?
Please indicate if any of the reason for the visit:(Required)
Is your pet on any Medications/Flea, Tick or Heartworm Prevention/Supplements/CBD oil. If yes, please select:(Required)
Did you give the parasite prevention as prescribed?(Required)

If yes, please contact us prior to your appointment date to receive a calming package. This will ensure we can complete a thorough physical exam and avoid having to reschedule your appointment if we are unable to.

We are practicing as a fear free clinic and would like our patients to be as comfortable as possible while in our care.

Would you like to be signed up for a free pet trial insurance?(Required)
We can sign you up to the email on file for a free trial. If you say YES, please check your email a few hours after your appointment. If you did not receive the notice, check your junk box before calling us to re-submit it to you. You will have about 24 hour to accept the offer then it will expire. Please remind us during your appointment to activate this for you.
Does your pet spend time outside?(Required)
Photo authorization(Required)
At times during your pet’s visit, we may take pictures. Your consent here will act as authorization to use these pictures on Roncesvalles Animal Hospital Facebook, Instagram and social media pages.
Hospital and Cancellation Policy(Required)
For payments we are accepting all major credit cards, Debit, e-transfers or cash.

1. Cancellation within 24 hours of APPOINTMENT time - $37.50
2. Missed APPOINTMENT or more than 10 minutes late for scheduled appointment time - $52.50
3. Missed drop off or cancellation within 72 hours of SURGERY time - $250
We appreciate your consideration and understanding of this policy.

Skip to content