Recheck Pre-Exam Form | Oakridge Vet Clinic

Your Name *

Best number to reach you during the exam? *

Pet's Name *

What are we rechecking your pet for? *

General Health

Are your pet's previous symptoms getting...? *

No Change

Better

Worse

Unknown

Please provide any information if symptoms are worsening or not improving.

If any apply from above, please explain.

Appetite & Activity

How has your pet's APPETITE been lately? *

How has your pet's ACTIVITY been lately? *

Medications

Is your pet currently taking medication? *

Yes

Please provide any information if symptoms are worsening or not improving.

Payment is expected at the time that service is rendered. We accept cash, checks, Visa, Mastercard, Discover, American Express, and CareCredit.

I, the undersigned owner or authorized agent of the above-admitted patient, hereby authorize the doctors of Oakridge Veterinary Clinic to administer such treatment as is necessary and to perform procedures therapeutically and/or diagnostically. I further understand that no guarantee of successful treatment is made. I also assume financial responsibility for all charges incurred and agree to pay all such charges at the time of release. I understand that unpaid balances over 30 days are subject to a monthly 1.5% finance charge. *

Acknowledged

Monday	8:00 am	6:00 pm
Tuesday	8:00 am	6:00 pm
Wednesday	8:00 am	6:00 pm
Thursday	8:00 am	6:00 pm
Friday	8:00 am	6:00 pm
Saturday	8:00 am	6:00 pm
Sunday	Closed

Recheck Pre-Exam Client Form

General Health

Appetite & Activity

Medications