780-250-1700
2531 – 17th Street NW Edmonton, AB
Links
Hit enter to search or ESC to close
Home
Contact
New Clients
What to Expect
New Client Registration Form
Prescription/Food Refill Request
About Us
Team and Pet Bios
Location & Hours
Make an Appointment
Veterinary Blog
Fear Free Clinic
Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Nutritional Counseling
Additional Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
News
Forms
Consent Forms
General Anesthesia Consent
Euthanasia Consent Form
Echocardiogram – Drop Off Consent Form
Drop Off Consent Form – with sedation
Drop Off Consent Form
Overnight Hospitalization – Drop Off Consent Form
Blood Glucose Curve – Drop Off Consent Form
Dental Surgery Consent Form
Surrender Consent Form
Spay/Neuter Surgery Consent Form
Telemedicine Consent Form
Ultrasound Consent Form
Admission Forms
Canine Patient Admission Form
Feline Patient Admission Form
Recheck Exam Admission Form
Questionnaires
Diarrhea Questionnaire
Vomiting Questionnaire
Itching Questionnaire
Canine Cognitive Dysfunction Syndrome Assessment
Shop Online
Feline Patient Admission Form
COVID Questionnaire
Have you or anyone in your household traveled outside of Canada in the last 14 days?
*
Yes
No
Are you currently exhibiting any of the following symptoms?
*
Yes
No
Fever, cough, shortness of breath, difficulty breathing, sore throat or painful swallowing, runny nose or stuffy nose, feeling unwell/fatigued, conjunctivitis, etc.
Have you or anyone in your household had close contact with someone who is being investigated or confirmed to be a positive case of COVID-19?
*
Yes
No
Are you bringing in an animal that has been in contact with a person that has or is COVID-19 positive in the past 14 days?
*
Yes
No
As a small business, we still have a mask mandate in effect. Please ensure that you have a mask on prior to walking into the clinic. You are required to provide your own mask for this visit. We appreciate your participation in this.
*
I CONSENT
Admission Questions
Consent for Required Carrier
*
I consent
I do not have a carrier for my pet, therefore, I will need TVC to provide one for me at time of curbside service.
Tamarack Vet clinic is not responsible for any cat that gets loose from the time of contact at the vehicle to entering the clinic. If you do not have a carrier for your cat, please let our staff member know and we will provide one for you.
Do you or any family members have any food allergies? (ie: peanut butter)
*
Yes
No
If yes, please list them:
*
Owner Name
*
First
Last
Pet Name
*
Age
*
Please specify weeks/months/years
*
Weeks
Months
Years
Sex
*
Female
Spayed Female
Male
Neutered Male
Reason for appointment
*
Describe in detail please
Duration of symptoms for current concerns?
*
Date of last vaccinations? What Clinic?
*
Any Previous Reaction to Vaccination?
*
Are there Any Other Pets in the Household/What Type?
*
How Many Cats In The House? How Many Litter Pans?
*
Select all that apply to your cat:
*
My Cat Goes Outdoors Unsupervised
My Cat Goes Outdoors Supervised
My Cat Will Board In A Kennel When We Are Away
My Cat Is A Hunter
My Cat Will Travel/Has Traveled Outside Of Alberta
My Cat Lives With A Cat Who Does Go Outside
None of the above apply to my cat
If your cat has travelled outside Alberta, please list where and when.
*
Date of Last Deworming? Product Used?
*
Brand of Food Fed? How Much/How Often? Canned/Dry?
*
Treats Fed/Brand?
*
List Current Medications and/or Supplements including dose:
*
If so, please list name/dose/last given
If your pet was prescribed any pre-visit medications (Gabapentin/Trazodone/Phenobarbital, etc), please list them and what time they were given (if none were given, put N/A):
*
Any Known Allergies?
*
Any environmental changes?
*
Any Reaction to Medications?
*
Any Concerns under Anesthesia?
*
Any Recent Change in Weight?
*
How is their appetite?
*
Poor
Good
Excellent
When did they last eat?
*
Has There Been Any Sneezing?
*
If so, please describe
Has There Been Any Coughing?
*
If so, please describe
Has There Been Any Vomiting?
*
If so, please describe
Has There Been Any Diarrhea?
*
If so, please describe
When was their last bowel movement?
*
Have You Noticed Any New Lumps?
*
Has There Been Any Recent Change In Drinking Or Urinating Amounts?
*
How is their behaviour?
*
Lethargic
Normal
Hyperactive
List Previous Health Concerns:
*
Do You Have Any Additional Current Concerns?
*
Do you have pet insurance, if so, what company?
Please list the policy number.
Consent
FOR NEW CLIENTS/PATIENTS ONLY - I hereby grant Tamarack Vet Clinic LTD permission to take photographs of myself and/or my pet(s), and to publish those photographs for any lawful purpose, including but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my name and/or my pet(s) name.
By signing and dating this document, I authorize Tamarack Vet Clinic LTD to edit, alter, share, remix, tweak, build upon or in any way alter the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my or my pet(s) images(s) and name(s) for the personal or commercial purposes outlined above.
Owner Signature
Best phone number to contact you during the time of appointment
*
Date
Date Format: MM slash DD slash YYYY
Home
Contact
New Clients
What to Expect
New Client Registration Form
Prescription/Food Refill Request
About Us
Team and Pet Bios
Location & Hours
Make an Appointment
Veterinary Blog
Fear Free Clinic
Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Nutritional Counseling
Additional Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
News
Forms
Consent Forms
General Anesthesia Consent
Euthanasia Consent Form
Echocardiogram – Drop Off Consent Form
Drop Off Consent Form – with sedation
Drop Off Consent Form
Overnight Hospitalization – Drop Off Consent Form
Blood Glucose Curve – Drop Off Consent Form
Dental Surgery Consent Form
Surrender Consent Form
Spay/Neuter Surgery Consent Form
Telemedicine Consent Form
Ultrasound Consent Form
Admission Forms
Canine Patient Admission Form
Feline Patient Admission Form
Recheck Exam Admission Form
Questionnaires
Diarrhea Questionnaire
Vomiting Questionnaire
Itching Questionnaire
Canine Cognitive Dysfunction Syndrome Assessment
Shop Online
Contact Us
Name
*
First
Last
Email
*
Phone
*
Pet Name
*
Preferred Date
*
MM
DD
YYYY
Preferred Time
*
:
HH
MM
AM
PM
Reason for appointment
*