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Hours 13055 Perry Highway
Wexford, PA 15090

Client Check-In Form

Pet Name*

Reason for Visit: (Describe briefly)

Decreased appetite/drinking?

Vomiting or diarrhea?

Any vaccine reactions or known allergies?

If yes- Please list here:

Any current Medications? Please list below.

Do you need any refills?

Flea and tick preventative:

Do you need any refills?

Heartworm prevention:

Do you need any refills?

Is your pet Lyme positive to your knowledge?

Current Diet/Any treats

Indoor/Outdoor/Both

Chronic Illnesses?

Boarding/Daycare/Grooming

If Yes, where?

Would it be ok for us to add a picture of your per on our website/social media? No personal information will be shared besides your pet’s name)?

Bradford Hills Veterinary Hospital