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

What is the reason for your pet's visit today? (If medical concern: when did you first notice the symptoms?)

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?

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

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?

Curbside Form

Get In Touch With Us

Location

Contact Us

Hours

Emergencies