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801-298-2014
86 N 70 W St, Centerville, UT 84014

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- New Client Registration Form
- Canine/Feline Pre-Visit Form
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Canine/Feline Pre-Visit Form

Pre-Visit Questionnaire K9/Fel
To help our team prepare and make the visit as smooth and stress-free as possible, please complete the short Pre-Visit Questionnaire PRIOR to your appointment. If we are seeing your pet because they are sick, please include as much detail as possible. We look forward to seeing you and your pet soon!
Date*
Date Format: MM slash DD slash YYYY
Pet Owner’s Name*
First Last
Phone Number*
Email*
Patient Name*
Species/Breed*
Age/Date of Birth*
Sex:*
Reason for Visit
What is the primary concern or reason for today's visit?
When did the issue start? Has the condition changed (worsened, improved, stayed the same)?*
Is your pet eating and drinking normally?*
- Yes
- No
What is your pet's primary diet? (Please list all foods, brands, amount and frequency)*
Does your pet get treats? (Please list brand, amount and frequency)
Has your pet been experiencing vomiting or diarrhea?*
- Yes
- No
Please describe symptoms and duration:*
Is your pet coughing or sneezing?*
- Yes
- No
Please describe symptoms and duration:*
Is your pet currently taking a flea/tick preventative?*
- Yes
- No
Please list the product name and frequency given:*
Is your pet currently taking a heartworm preventative?*
- Yes
- No
Please list the product name and frequency given:*
Is your pet currently taking prescription medication(s) and/or supplements?*
- Yes
- No
Please list the medication and/or supplement name(s), frequency given, and prescriber’s name:*
Please list the condition for which your pet’s medication was prescribed:*
Do you need medication refills?*
- Yes
- No
Please list the medication name(s), frequency given, and prescriber’s name:*
Behavior and Activity
Does your pet have anxiety?*
- Yes
- No
Please describe symptoms and activities surrounding anxiety episodes:*
Have you noticed your pet behaving abnormally recently?*
- Yes
- No
Please describe symptoms and duration:*
Medical History
Does your pet spend time scratching/licking/chewing their skin/fur?*
- Yes
- No
Please describe symptoms and duration:*
Does your pet experience stiffness/soreness?*
- Yes
- No
Please describe symptoms and duration:*
Have you noticed any new lumps or growths on your pet?*
- Yes
- No
Please describe describe the location and when the change was first noticed:*
What is your pet’s typical environment (i.e. stays at home, visits local dog parks/attractions, travels frequently)?*
Are you planning to board your pet in the near future?*
- Yes
- No
Please list upcoming boarding dates and facility:*
Has your pet stayed at a boarding facility since your last visit?*
- Yes
- No
Reproductive History
Please list most recent boarding dates and facility:*
Has your pet had litters before?
Any history of reproductive issues? If yes, please explain:
When was your pet's last heat cycle?
Please list any additional health history you’d like to share:*
Has your pet been seen at a different clinic, ER hospital, or facility recently? If yes, please indicate any surgeries, procedures, or concerns and the name of the hospital.
Authorization
Consent*
I authorize the examination and treatment of my pet by the veterinary team at Parrish Creek Veterinary Hospital and Diagnostics Center. I acknowledge that I am responsible for all associated costs at the time of service.
File
Drop files here or
Please feel free to include a photo of your pet to add to their chart!

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Where To Find Us

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 6 pm
Thur: 8 am – 6 pm
Fri: 8 am – 6 pm
Sat: 8 am- 2pm
Sun: Closed

86 N 70 W St
Centerville, UT
84014-1821

Call: 801-298-2014
Email: info@parrishcreekvet.com

Make An Appointment

© 2025 Parrish Creek Veterinary Hospital & Diagnostics Center.
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About Us
Forms
- New Client Registration Form
- Canine/Feline Pre-Visit Form
Services
- Make an Appointment
Pet Health
Payment Options
Online Pharmacy
- Shop Online
- Purina Vet Direct
Contact Us
- Make an Appointment
Make an Appointment

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instagram