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Curbside Service Form

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Curbside History Form

Please have this form completed before coming to the hospital. Your pet will be brought into the hospital by a team member, the doctor will do an exam and any questions/conversations will be by phone. Please have a cell phone ready and the number of that phone on this form. Payment of services will be curbside as well, and expected after the visit is complete.

Select a Location *

Name *

Email *

Cell Phone *

Pet Name *

Car Make/Model/Color *

Date *

Notifying us of your arrival
Please call our office once you have arrived.

Curbside appointment
Please arrive 10mins before your appointment time.
If your pet is scheduled for a routine annual exam, we recommend yearly blood work and viral screening, fecals checked twice yearly and vaccines due updated. We will provide an estimate of what we have in our records that is needed for your pet for you to review when we come to your car.

Please call our office once you have arrived
Please have your pet on a leash or in a carrier before we come to the car.
Please bring a fecal and urine sample, so if needed it is available.

Briefly describe the reason your pet is here for an exam, such as ear infection, sick or limping. Please answer all questions below regardless of why your pet is here.

Has your pet had any coughing ?

Yes No

Has your pet had any sneezing ?

Yes No

Does your pet have any nasal discharge?

Yes No

Has your pet been vomiting?

Yes No

Has your pet had diarrhea?

Yes No

Does your pet’s stool look normal in color?

Yes No

Has your pet been drinking more?

Yes No

Has your pet been urinating more?

Yes No

Have you seen your pet’s urine?

Yes No

Has your pet’s appetite changed?

Yes No

When was the last time you saw a bowel movement and what did it look like?

Any change in diet?

Yes No

Is your pet lethargic (not active)?

Yes No

Is your pet here because it is limping?

Yes No

Please list all medications your pet is on and when they were last given:

Has your pet cried out?

Yes No

Does your pet have a problem with one or both of its eyes?

Yes No

Does your pet have a problem with one or both of its ears?

Yes No

Do you have a concern with your pet’s teeth?

Yes No

Would you like your pet’s nails trimmed while here?

Yes No

Comment if any concerns with the nails.

Would you like your pet’s anal glands emptied? Comment if any concerns with them, any scooting or licking?

Are there any new lumps or bumps you have found?

Yes No

Please tell us any information that you feel would be helpful in treating your pet today. We will do our best to have your pet seen and communicate a plan as quickly as possible.

Your pets deserve the best veterinary care possible

Contact Us Today!

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Main Office

10475 Crosspoint Blvd, Suite 220
Indianapolis, IN 46256
* Pets are NOT SEEN at this location

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info@petwellnessclinics.com

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317-288-0923

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OFFICE HOURS

Monday - Friday: 7:00 AM - 6:00 PM
Saturday: 8:00 AM - 2:00 PM
Binford, Springmill, and Noblesville Only
Sunday: 9:00 AM - 4:00 PM
Binford Location Only

LOCATIONS

Avalon Animal Clinic: 317-842-4618
Binford: 317-578-1298
Bridgeview: 317-841-3315
Broad Ripple: 317-588-8181
Brownsburg: 317-520-3232
Carmel: 317-795-1295
College Park: 317-790-2800
Geist: 317-827-0970
Ingalls: 317-284-0729
Noblesville: 317-900-7436
Springmill: 317-399-1832
Zionsville: 317-343-9933

Click Here for Emergency After Hours Care

We accept cash, check, major credit cards, care credit and also offer Pet Prime®

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