Exotic Pet Care & Curbside Form – White Rock Veterinary Hospital in Pflugerville, Texas

Date and time of appointment?*

Name

First Last

Email

Phone to reach you at while you're here

Type of pet you're bringing in

Type of pet

What is the model and color of the vehicle you will be driving to your pet's visit?

Pet's name

Any known allergies?

Allergies

Diet (brand, how much per day, treats)*

Current medication(s), including preventatives, and/or supplement(s)

Which preventative(s) is your pet on?

Trifexis (Heartworm/Flea)
Interceptor (Heartworm)
Credelio (Flea/Tick)
Revolution (Heartworm/Flea)
None
Other (specify below)

Other

Do you need any prescription(s) or preventative(s) refilled at your pet's visit? (If yes, please list which medication(s), strength and quantity you would like refilled.)

Lifestyle of your pet

Indoor Only
Indoor - occasional outdoor trips
Indoor/Outdoor
Outdoor Only
Goes to doggy day care, boarding, grooming or dog parks
Other (specify below)

Other

How is your pet's appetite? Eating normally?

Water Details*

Appetite Details*

Any changes in water consumption or urination?*

Water Details

Have you noticed any vomiting?

Vomit Details

Have you noticed any diarrhea, constipation, or other stool abnormalities?

Details

Have you heard/seen any coughing, sneezing, nasal discharge, or other respiratory signs?

Details

Have you noticed any limping, pain, stiffness, or other mobility concerns?

Details

Have you noticed any skin or ear problems - itching, head shaking, chewing, or scooting?

Details

Have you noticed any new lumps or bumps and/or changes in existing lumps?

Details

Please provide any additional information from the previous questions below; or concerns that you would like to discuss at your pets visit?

Photo Release Form

Unless declined I understand that my pet's photo may be used on White Rock Veterinary Hospital's website and social media to help maintain, expand, and educate the public about our services.

I choose not to have my pet's photo shared.

Curbside Form

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Location

Contact Us

Hours

Emergencies