931-363-7971 gcahoffice@gmail.com

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Curbside Check-In Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

dog sitting in a car

Curbside Check-In Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 931-363-7971 for a faster response.

I am in this vehicle *

(please list model & color)

Best Phone number for today's appointment *

(the Veterinarian and technician will use this number to communicate with you through the appointment if you choose to remain curbside.)

Email *

Patient's Name *

Patient's Species *

Canine
Feline
Exotic

Please specify

Owner's Name *

First

Last

Have you booked your appointment yet? *

Yes
No

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

If your pet is an exotic (bird or reptile) or pocket pet species (bunny, ferret, guinea pig, rat, hamster or chinchilla etc.) Please describe it’s environment & nutrition regimen & photos of enclosure if possible

Patient's Energy Level

Normal
Increased
Decreased

List ALL medications your pet is currently taking. Please include dosage, frequency, and any flea/tick/heartworm or over the counter (including CBD) products.

Do you need refills of any of these medications

Yes
No

If you need a medication refill, please list which medications

If you do not need a refill, please put N/A.

Please list what diet / food your pet currently eats (include brand & feeding schedule) and all treats and how often given.

Do you need refills on any prescription pet food?

Yes
No

If you need a prescription pet food refill, please let us know which kind

Patient's Appetite

Normal
Increased
Decreased

Drinking / Water Intake

Normal
Increased
Decreased

Is the patient coughing?

Yes
No

If yes, for how long?

Is the patient sneezing?

Yes
No

Is the patient vomiting?

Yes
No

If yes, for how long?

NEW CLIENTS/PETS - Does your pet have any previous diagnoses?

Yes
No

If yes, please explain

Have you or your pet traveled out the area?

Yes
No

If yes, where?

Is your pet regularly taken for grooming?

Yes
No

Is your pet regularly taken for boarding?

Yes
No

Does your pet go to dog parks?

Yes
No

Is your cat kept strictly indoors, or is he/she an indoor/outdoor cat?

Indoor Only
Indoor/Outdoor

Does your pet have any lumps, bumps, or masses? If yes, please describe where on the pet's body they are located.

Please upload any necessary medical records

Click or drag files to this area to upload. You can upload up to 5 files.

Signature *

Clear Signature

Email

Ready for a visit?

We proudly serve the pets of Pulaski, Lynnville, Columbia, Lewisburg, Minor Hill, Prospect, Lawrenceburg, Fayetteville, Athens, Ardmore, and beyond. We look forward to seeing you and your pet! Easily request an appointment for your pet using our online system.

We're here to help.

Have a question? Complete our online form, and a member of our team will be in touch with you shortly.

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Find Us

16654 W. College St.
Pulaski, TN 38478

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Get in Touch

931-363-7971 (call or text)
gcahoffice@gmail.com

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Our Hours

Mon–Fri: 7:30 am to 5:00 pm
Sat: 7:30 am to 12:00 pm *
Closed: 1:00 pm to 2:00 pm

* Please note we are only open one Saturday each month.

Name *

First

Last

Email *

Phone

How can we help you? *

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