Russell Vale Animal Clinic

17 Bellambi Lane
Bellambi, NS 2518

(024)284-5988

www.animalclinic.com.au

Thank you for filling out this information prior to your online appointment, as this will ensure you get the maximum benefit.  


Owner's Name
Owner's Surname
Contact Phone Number
Email

Pet details
Pet's name
Age or date of birth
Breed
Estimated Weight
Sex (male/male desexed/Female/Female desexed
Colour

General Health questions
Describe what your feed your pet
Heartworm Prevention
Flea/Tick control
Intestinal Worming
Current medications or supplements your pet takes
Any existing or previous medical conditions we may not be aware of?

About your visit
Primary reason for your visit
Eating normally?
Drinking normally?
Any vomiting or diarrhoea? If yes, please describe.
Any coughing or trouble breathing?

If it is a skin problem, answer these, otherwise move to the next section
How itchy is your pet
What areas are affected
Sore ears?
We will email for further skin questions

Other
If there is any other information we need we will email it to you directly.
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