New Patient Questionnaire

Welcome to the Small Animal Clinic at Piedmont Equine! Thank you for taking time so that we can better get to know your pet.

Your name:
First Last
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:
Email:
Best way to reach you:
Pet name:
Sex:
Spayed or Neutered
Cat/dog/other:
Breed:
Date of birth/age:
Color:
Microchip or tattoo:
Pet insurance:
How long have you owned your pet?
Where/how did you get your pet?
Other pets in household:
Lifestyle: barn cat, indoor cat, farm dog, goes to groomer, goes to kennel/dog parks.
Diet: including treats, chews, people food.
Medications: heartworm preventatives, flea and tick preventatives, supplements.
Allergies: seasonal, food, drugs.
Behavioral issues: house soiling, anxiety, noise phobias, aggression, fearfulness.
Handling preferences: loves treats, scared at the vets, likes a chin rub, hates feet touched.
Any major health issues?
(surgeries, hospitalizations, emergency visits, lamenesses, dentals etc)
In order for us to be better prepared and informed, please provide us with any previous health and vaccine records by email at office@piedmont.vet prior to your appointment, or allow us to contact your previous veterinarian.

Office medication policies;

-Please allow 24 hours for medication refills so that records may be reviewed by the doctors
-As with any pharmacy, no drugs may be returned.
-According to Virginia State law 54.1-3222, we are unable to prescribe medications to pets that have not been seen by our practice.

We love our patients! May we post photographs of your pet to share on our social media?
Please sign your name to verify the above information is accurate:
Name Date
We look forward to meeting your pet!

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New Patient Questionnaire

We look forward to meeting your pet!

Exceptional veterinary care in The Plains, VA

Below you will find contact information for our veterinary practice in The Plains. Please call us to make an appointment- 540-364-4954.

Address

Contact

Hours

Equine