Curbside Check-In Form

Name: The Pet Hospital
Address: 501 E Virginia Ave, Bessemer City, NC, 28016, United States
Telephone: 704-629-5390
Price range: $

Please fill out the form as completely as accurately as possible.

Get Started

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 704-629-5390 for a faster response.

Curbside Questions

I am in this vehicle: *

(Please list the model and color.)

Best phone number for today's appointment: *

(The veterinarian and technician will use this number to communicate with you through the appointment.)

Patient's Name *

Patient's Species *

Canine
Feline
Other

If 'Other', please specify: *

Owner's Name *

First

Last

Appointment Date/Time *

Date

Time

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

Patient's Energy Level

Normal
Increased
Decreased

Please list the medications your pet is currently taking:

Do you need refills of any of these medications?

If you need a medication refill, please list which medications:

Do you need refills on any prescription pet food?

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?

If yes, for how long?

Is the patient sneezing?

If yes, for how long?

Is the patient vomiting?

If yes, for how long?

Please upload any relevant records or photos below:

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

Phone

Book an Appointent

We can't wait to meet you! We proudly serve the pets of Bessemer City, NC and beyond. Download our PetDesk app to access your pet’s medical records, receive automatic reminders, and more!

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