Name: Russell Lake Animal Hospital
Address: 19 Norm Newman Dr., Dartmouth, NS, B2W 6M3, Canada
Telephone: 902-407-4570
Price range: $

Owner Name *

First

Last

Phone *

Email *

Would you prefer to be contacted by text, email or phone call? *

Text
Email
Phone call

Who should we contact to make medical decisions today? *

Owner (Named Above)
Someone Else (Named Below)

Who should we contact to make medical decisions today? *

First

Last

At what number can they be reached today? *

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/date of birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

When did you get your pet? *

Where did you get your pet? *

If other, please specify *

What kind of food do you feed your pet? *

How much do you feed? *

Free fed (food is offered always/whenever hungry)
Measured amount

Measured amount *

Has your pet received any vaccinations?

Yes
No

If yes, what date & vaccine was given? *

Has your pet received any deworming or flea and tick medication?

Yes
No

If yes, what date and product was given? *

Many of our patients love peanut butter as a snack while visiting our office, but if you or your pet have an allergy to peanut butter, please let us know.

Can your pet have peanut butter? *

Yes
No

Are there any concerns for the following: (check all that apply)

If there are concerns, how long has your pet been experiencing this problem and what symptoms have they been experiencing? *

If other, please specify *

Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure? *

Yes
No

Please explain *

Is your pet on any medications? *

Yes
No

If yes, please specify *

I understand that financial responsibilities for services are rendered at the time of discharge. *

I understand

Appointments: Please arrive a few minutes early or on time to check in. Late arrivals may not be accommodated and a late fee of $50 may be applied to your account. Once the exam has been performed and a plan has been discussed we will obtain your consent and proceed with providing treatment. *

I have read and understand

Social Media/Photo Permission: Do we have your permission to post photos of your pet online? *

Yes
No

I certify that I am 18 years of age or older and responsible for the financial and medical decisions for the above mentioned pet. *

I agree
I disagree

Please type your initials. *

Date *

Please text photos of your pet's records to 902-407-4570 and/or bring any paperwork with you to the appointment so that your veterinarian knows which vaccines or treatments have already been started.

Privately Owned & Proudly Canadian 🍁

New Puppy/Kitten History Form

Complete the New Puppy/Kitten History Form

Complete Your New Puppy/Kitten History Form

Are you ready for a visit with us?

We serve the pets of Dartmouth and beyond!

We’re open seven days a week to make sure your pet gets the care that they need.

Call Us

Visit Us

Email Us

Download Our Free App!