ADAIR COUNTY ANIMAL HOSPITAL & LASER SURGERY CENTER
  • About Us
    • We are AAHA Accredited!
    • Our Team
    • Success Stories & Reviews
    • Visit Expectations
    • Community Involvement
  • Services
    • Emergency
    • Laser Surgery >
      • What is CO2 Laser Surgery?
      • Spays & Neuters
    • Boarding >
      • Pet Health Requirements
    • Teeth Cleaning & Digital Dental X-Ray
  • Contact Us
    • Emergency
    • Appointment Request
    • Boarding Reservations
    • Refill Food & Prescriptions
  • Forms
    • Exam: Patient History Questionnaire
    • New Client Info
    • General Admit Form
    • Boarding Admit Form
    • Teeth Cleaning Consent
    • Record Release Form
  • Wellness Plans
    • Wellness Plans Frequently Asked Questions
    • Puppy & Kitten Plans
    • Adult: Dog & Cat Plans
  • Pet Parent Resources
    • Monthly Special
    • Online Pharmacy
    • Pet Health Library
    • Petly: Online Records
    • Loyalty Rewards Program
    • Refer A Friend
    • Payment Options >
      • Scratchpay
      • Care Credit
      • Pumpkin Pet Insurance
  • Apply
  • Training

Patient History Questionnaire


For a faster exam visit, please fill out the following history questions about your pet BEFORE your appointment.  Submit one questionnaire per pet.
​
Options:

1.) Instant:  Fill out the patient history on this page and submit it electronically by clicking "SUBMIT" at the bottom. You will receive a confirmation message that it was sent to us.

2.) Print and Return:  You may also fill out the patient history form by hand by printing the attached PDF file. Bring it with you to your pet's appointment.
​
Printable Patient History Questionnaire
File Size: 102 kb
File Type: pdf
Download File

To continue to improve the service and communication we provide, we will be testing several different forms and form styles.  Feel free to give us some feedback.  We appreciate your patience as we grow in excellence!


    MEDICATIONS:
    If yes, list any current maintenance medications, this includes oral, medicated shampoos, injections, topicals, etc.  Please bring all current medications to your pet's appointment.

    DAILY CARE:

    WRAPPING UP:
SEND

Adair County Animal Hospital & lASER sURGERY cENTER


(Main Office) 270-384-6113
2004 Campbellsville Road, Columbia, KY 42728
Office Hours
Emergency 
Services
​

Pet Owner Resources


Registration & Admit Forms
Online Pharmacy

Petly- Online Records
Pet Health Network
Wellness Plans​
Pumpkin Pet Insurance
​​Scratch Pay

American Animal Hospital Association (AAHA)
Site powered by Weebly & IDEXX Laboratories. Created & Maintained by A.W.
  • About Us
    • We are AAHA Accredited!
    • Our Team
    • Success Stories & Reviews
    • Visit Expectations
    • Community Involvement
  • Services
    • Emergency
    • Laser Surgery >
      • What is CO2 Laser Surgery?
      • Spays & Neuters
    • Boarding >
      • Pet Health Requirements
    • Teeth Cleaning & Digital Dental X-Ray
  • Contact Us
    • Emergency
    • Appointment Request
    • Boarding Reservations
    • Refill Food & Prescriptions
  • Forms
    • Exam: Patient History Questionnaire
    • New Client Info
    • General Admit Form
    • Boarding Admit Form
    • Teeth Cleaning Consent
    • Record Release Form
  • Wellness Plans
    • Wellness Plans Frequently Asked Questions
    • Puppy & Kitten Plans
    • Adult: Dog & Cat Plans
  • Pet Parent Resources
    • Monthly Special
    • Online Pharmacy
    • Pet Health Library
    • Petly: Online Records
    • Loyalty Rewards Program
    • Refer A Friend
    • Payment Options >
      • Scratchpay
      • Care Credit
      • Pumpkin Pet Insurance
  • Apply
  • Training