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
    • Physical Therapy >
      • Laser Therapy
      • Massage Therapy
    • 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
  • Pet Parent Resources
    • Payment Options >
      • Scratchpay
      • Care Credit
      • Pumpkin Pet Insurance
    • February Special
    • March Special: PREVIEW
    • April Special: SNEAK PEEK
    • Tail Tips: DVM Blog
    • Pet Health Library
    • Petly: Online Records
    • Refer A Friend
    • ACAH Loyalty Rewards Program
  • Online Pharmacy
  • Wellness Plans
    • Wellness Plans Frequently Asked Questions
    • Puppy & Kitten Plans
    • Adult: Dog & Cat Plans
  • Apply
  • Training

Patient History Questionnaire


For a faster exam visit, please fill out the following health history questions about each of your pet(s) BEFORE the scheduled appointment(s).  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 be sent back to our website's home page as a confirmation that this questionnaire was received.

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
Tail Tips: DVM Blog
Online Pharmacy
Petly- Online Records
Wellness Plans​
Pumpkin Pet Insurance
​​Scratch Pay

American Animal Hospital Association (AAHA)
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  • 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
    • Physical Therapy >
      • Laser Therapy
      • Massage Therapy
    • 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
  • Pet Parent Resources
    • Payment Options >
      • Scratchpay
      • Care Credit
      • Pumpkin Pet Insurance
    • February Special
    • March Special: PREVIEW
    • April Special: SNEAK PEEK
    • Tail Tips: DVM Blog
    • Pet Health Library
    • Petly: Online Records
    • Refer A Friend
    • ACAH Loyalty Rewards Program
  • Online Pharmacy
  • Wellness Plans
    • Wellness Plans Frequently Asked Questions
    • Puppy & Kitten Plans
    • Adult: Dog & Cat Plans
  • Apply
  • Training