Drop 'n' Go Wellness Questionnaire
Please complete this questionnaire before you arrive at your Drop 'n' Go appointment. Doing so means you do not have to wait around and we can attend to your pet's health check up and vaccines quickly. If there is anything else we need to know then we'll call you during the day.
Your DetailsName
Address
Telephone Number
Mobile
Wellness history
Is your pet fit and well to the best of your knowledge? If No, please describe / Yes
No
What do you feed your pet?
Has their appetite / Increased
Decreased
No change
How would you describe your pets drinking habits? / Increased
Decreased
No change
Which answer best describes your pet's exercise ability? / Increased
Decreased
No change
Has your pet ever reacted badly to any medications including vaccination?
If the answer is YES then please tell us what medicine and briefly what happened: / Yes
No
Has your pet suffered any of the following problems in the past 12 months / Coughing
Sneezing
Breathing Problems
Itchy skin
Sore ears
Smelly breath
Diarrhoea
Sickness
Lumps or bumps
Limping
Pain
Seizures
What products do you currently use to control ticks, fleas, lung and intestinal worms?
If unsure, would you like us to treat your pet during their stay?
Please list any other products you would prefer us to use: / Please can you treat my pet with:
Combined Flea and Wormer Treatment
(includes Lungworm, but not tapeworm)
Advocate
Flea treatments:
Frontline Combo Spot On
Flevox
Stronghold
Worming treatments:
Drontal
Milbemax
Profender Spot on (cats only)
Panacur Granules
Your Drop 'n' Go Requests
You pet will receive its annual wellness health checkup and/ or vaccination.
However we do recommend some additional tests to make sure they stay fit and healthy.
In particular we recommend pets of all ages have annual urine test. For those over eight years of age we highly recommend a blood test and blood pressure measurement to look out for any problems as early as possible.
Please indicate which additional tests you would like us to perform. (All tests - including blood samples are easy to do and painless as we use a local anaesthetic cream to numb the skin beforehand).
Emergency Treatment
If deemed necessary by the veterinary surgeon during your pets stay. / Annual Vaccination
(includes full health check prior to vaccination)
Annual Wellness Urine Sample £11.40
Blood Pressure Monitoring £25.00
Annual Wellness Blood Screen £75.00
Compulsory
Please tick if required.
I authorise the vet to provide the treatments and services requested above.
I understand that should my pet become severely unwell during their stay at the practice, that the vet can provide emergency treatment until I have been contacted.
Signed…………………………………….. / Date ………………………………..
Staying on ……………………………….
PLEASE NOTE
If your pet is unwell on the day of their stay, we will need to speak to you during the day to advise of any treatments they may need, we can schedule a time (perhaps during your lunch hour?) where you can authorise by telephone any treatments they may need.
Should we be unable to contact you and your pet becomes severely unwell in our care we will provide emergency treatment until we can make contact with you.
By signing this form it allows us to provide the best possible care whilst you can carry on with your day.
Only those treatments or vaccinations requested on this form will be given during your pet’s stay. No additional treatments other than those requested on the form, or discussed by telephone will be provided.
Failure to complete any part of this form will result in the stay being cancelled. For assistance in completing this form please speak to reception.
Thank you for letting us take care of your pet.
Internal Use Only
Time / Initials / CommentsDrop off time
Collection time
Owner called during stay
Items left / Collar/ lead / Bowl/bottle/ food / Toys
Registered Office• Kapsapea Ltd T/A Castle Veterinary Practice •3 Robins Drive • Bridgwater • Somerset • TA6 3DB
Vat Reg No. 864 9340 92 • Company Reg No. 05448378