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Fryeburg Veterinary Hospital

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Pre-Visit Form

"*" indicates required fields

Client Full Name*

Pet Name*

Client Email Address*

Client Phone Number*

Consent

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Home address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

What kind of food are you currently feeding your pet?*

How much and how often do you feed?*

Do you use flea/tick prevention for your pet?*

Yes

No

what kind?

Do you use this year-round or seasonally?*

Yes

No

When was their last dose?

Do you use heartworm prevention for your pet?*

Yes

No

what kind?

Do you use this year-round or seasonally?

When was their last dose?

Does your pet currently take any medications?*

Yes

No

what medication(s)?

What is the dose and how often do you give it?

Do we have your permission to photograph your pet and use the image(s) on our social media?*

Yes

No

Do you have any other questions/comments/concerns that you would like addressed at your next visit?*

Signature*

Date*

MM slash DD slash YYYY

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Home
Our Hospital
Services
AAHA-Accredited Practice
Contact Us

Get in touch

207-935-2244

203 Bridgton Road,
Fryeburg, ME 04037

Make an appointment

Fryeburg Veterinary Hospital

207-935-2244

203 Bridgton Road,
Fryeburg, ME 04037

Make an Appointment

Online Pharmacy

Home
Our Hospital
Services
AAHA-Accredited Practice
Contact Us

Business Hours

Monday

7:30am - 6:00pm

Tuesday

7:30am - 6:00pm

Wednesday

7:30am - 6:00pm

Thursday

7:30am - 6:00pm

Friday

7:30am - 6:00pm

Saturday

8:00am - 6:00pm

Sunday

Closed

*Closed 12-2 Thursdays

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