Complete your curbside drop-off form online!

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). During this time, we are asking all clients to fill this out prior to their pet’s appointment. Please note: In order to schedule an appointment, please 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.

Is there anyone in your household or who has been in contact with your pet that is ill with COVID-19 or COVID-19 like symptoms? If so, we will use additional personal protective equipment. *

I am in this vehicle: *

(please list model & color)

Best Phone number for today's appointment: *

(the Veterinarian and technician will use this number to communicate with you through the appointment.)

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) *

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

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