Please complete the online check-in form prior to your appointment.

Name: Animal Hospital of Peak Plaza
Address: 1767 West Williams Street, Apex, NC, 27523, United States
Telephone: 919-362-0515
Price range: $

Thank you for giving Animal Hospital of Peak Plaza the opportunity to care for your pet(s). Please note: In order to schedule an appointment, call our team at 919-362-0515 or click here to request an appointment online. Please schedule your appointment prior to completing the check-in form below.

Have you, anyone in your household, or anyone you have been in contact with tested positive for, or been ill with, COVID-19 or had COVID-19 like symptoms? *

Patient's Name *

Patient's Species *

Canine
Feline
Exotic or pocket pet

Please specify *

Owner's Name *

First

Last

Owner's Email *

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

What kind/brand of food are you feeding your pet and how much per day?

Have you noticed any new growths or bumps? lf so, where are they located?

Patient's Energy Level

Normal
Increased
Decreased

List Medications your pet is currently taking

Do you need refills of any of these medications

If you need a medication refill, please list which medications

Do you need refills on any prescription pet food?

If you need a prescription pet food refill, please let us know which kind

Patient's Appetite

Normal
Increased
Decreased

Drinking / Water Intake

Normal
Increased
Decreased

Is your pet coughing?

If yes, for how long?

Is your pet sneezing?

If yes, for how long?

Is your pet vomiting?

If yes, for how long?

Is your pet having any diarrhea?

If yes, for how long?

Does your pet have any food allergies?

If yes, please explain.

Is it ok if we give your pet a treat?

Does your pet require any special handling? (i.e. muzzle, history of back surgery so careful around, back, etc)

If yes, please explain.

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

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