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410 -751- 0091

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At Antrim Veterinary Hospital, the doctors and staff have prided themselves on providing complete, high-quality care for dogs and cats in Taneytown since 1995.

Antrim Veterinary Hospital is dedicated to keeping pets happy, healthy and safe.

Pre Visit Questionnaire
Please complete prior to your pet's scheduled appointment

First & Last Name

Phone

Appointment Date

Pet's Name

Reason for Visit

Vaccines

Allergies (licking, scratching)

Ear infection

GI upset (vomiting, diarrhea)

Other

If other, please explain:

Please list the brands and product names and the amount of ALL foods, treats, snacks, dental hygiene products, rawhides and any other food that your pet currently eats, including food used to administer medications.

Has your pet had any diarrhea or vomiting?

Has your pet been coughing or sneezing?

Please list all current medications

Current heartworm prevention

Nexgard PLUS (heartworms, fleas and ticks)

Heartgard (heartworms only)

Other

None

If other, please provide name

Current flea and tick prevention

Nexgard PLUS (fleas, ticks and heartworms)

Nexgard (fleas, ticks only)

Frontline

Other

None

If other, please provide name

If there is anything needed other than what your appointment has been scheduled for, please let us know. We may reach out to you if your appointment time needs to be adjusted based on these requests.

Thanks for submitting! We look forward to seeing you soon!

520 E. Baltimore St. STE. 200 Taneytown, MD 21787 410-751-0091

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Pre Visit Questionnaire Please complete prior to your pet's scheduled appointment

Pre Visit Questionnaire
Please complete prior to your pet's scheduled appointment