IMED Recheck Form – Frederick

Thank you for giving us the opportunity to care for your pet. Please complete the form below prior to your recheck appointment.  

Click HERE for a PDF version of this form.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Phone

Pet's Name

How has your pet been doing since the last visit?

Current medications

Current diet

Any vomiting?

• Yes
• No

Any diarrhea?

• Yes
• No

Any coughing?

• Yes
• No

Any sneezing?

• Yes
• No

Any excessive thirst and urination?

• Yes
• No

Appetite level?

• Normal
• Increased
• Decreased

Please explain

Any other questions or concerns?

Name Any

*

• Please be advised that we are happy to interpret future bloodwork/testing from your primary care veterinarian; however, a diagnostic consultation fee will apply. This fee will vary depending on which lab panel is recommended and it accounts for the time spent interpreting the test results, formulating a plan, and communicating that plan to any parties involved. By checking this box, I acknowledge that there will be an additional charge for this service.

If your pet has been prescribed any anti-anxiety medication (such as Trazodone or Gabapentin), please ensure that you give it at least 2 hours before the IMED consult.

Submit