24-HR ER: 858-875-7500
Our Services
Blood Bank
Cardiology
Veterinary Dentistry
Dermatology
Diagnostic Imaging
Emergency/Critical Care
Internal Medicine
Neurology
Oncology
Ophthalmology
Social Work
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Urgent Care by Ethos Near Here
For Your Pet
Client Registration Form
Emergencies + Appointments
When Your Pet is a Patient
Client Portal
Prescription Refill Form
Online Store
Grief Resources
Pet Insurance
Clinical Studies
For Veterinary Teams
Submit Referrals
Our Referral Process
At a Glance
Ethos Materials for Clinics
Continuing Education
VetBloom CE
Clinical Studies
About Us
Our Hospital
Our Team
Why Ethos?
Veterinary Urgent Care by Ethos
Ethos Discovery
Contact Us
Blogs & Videos
Our Blogs
PAWEDcasts
We’re Hiring!
Apply Today
Job Fair Events
Benefits and Perks
Veterinary Training Programs
Our Services
Blood Bank
Cardiology
Veterinary Dentistry
Dermatology
Diagnostic Imaging
Emergency/Critical Care
Internal Medicine
Neurology
Oncology
Ophthalmology
Social Work
Surgery
Urgent Care by Ethos Near Here
For Your Pet
Client Registration Form
Emergencies + Appointments
When Your Pet is a Patient
Client Portal
Prescription Refill Form
Online Store
Grief Resources
Pet Insurance
Clinical Studies
For Veterinary Teams
Submit Referrals
Our Referral Process
At a Glance
Ethos Materials for Clinics
Continuing Education
VetBloom CE
Clinical Studies
About Us
Our Hospital
Our Team
Why Ethos?
Veterinary Urgent Care by Ethos
Ethos Discovery
Contact Us
Blogs & Videos
Our Blogs
PAWEDcasts
We’re Hiring!
Apply Today
Job Fair Events
Benefits and Perks
Veterinary Training Programs
24-HR ER: 858-875-7500
858-875-7500
Oncology Check-in
Existing Oncology clients, please submit this form on the day of each appointment.
Patient Information
Pet Owner First Name
*
Pet Owner Last Name
*
Patient Name (Pet's Name)
*
If you are leaving your dog or cat with us today, where can we reach you?
*
Please Note: if we are unable to reach you during the day, treatments and subsequently pick up times may be considerably delayed.
Email
*
This field allows us to send you a copy of this form for your records
What time works best for you to pick up your dog or cat?
*
4:00 - 5:00 pm
5:00 - 6:00 pm
6:00 - 7:00 pm
Please understand that we will attempt to have your pet ready by the time specified above, but that unexpected circumstances may not allow this. We recommend that you call 1 hour before this time to obtain an updated discharge time.
Condition Update
Date
*
Month
Day
Year
How would you rate your cat or dog’s current status?
*
Excellent
Good (good quality of life, but not 100%)
Fair
Poor
Very Poor
Please comment on each of the following since your last visit:
Lethargy
*
None
Mild
Moderate
Severe
If you have reported Lethargy, has the problem been noted during the last 48 hours?
Yes
No
Vomiting
*
None
Mild
Moderate
Severe
If you have reported Vomiting, has the problem been noted during the last 48 hours?
Yes
No
Diarrhea
*
None
Mild
Moderate
Severe
If you have reported Diarrhea, has the problem been noted during the last 48 hours?
Yes
No
Appetite
*
Increased
Normal
1/2 of Normal
Not Eating
If you have reported a change in appetite, has the problem been noted during the last 48 hours?
Yes
No
Drinking
*
Increased
Normal
1/2 of Normal
Not Eating
If you have reported a change in drinking, has the problem been noted during the last 48 hours?
Yes
No
Do you have any other symptoms to report? Please let us know if they are new within the last 48 hours
Medications
This information helps us ensure that outside pharmacies have properly filled prescriptions, that our instructions are accurate and being followed, and allows us to record medications that may have been prescribed by another hospital. Please indicate whether a listed medication has been initiated since your last visit here and indicate whether you need a refill on any medications.
Please list all current medications so we may keep records accurate at all times.
Medication & Strength
Dose (e.g. 1 tab, twice per day)
New Medication? Yes/No
Refill Needed? Yes/No
Do you have any specific questions or concerns?
Yes
No
If you answered "Yes", please share your questions below.
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