Surgery & Orthopedics Patient History Form | Austin Veterinary Emergency Center

Call Us Today 512-343-2837

7300 Ranch Rd 2222 Bldg 5, Suite 100, Austin, TX 78730
Email: info@austinvets.com
Emergency Hours: 24/7/365
Specialty Hours*: M – Sat: 8am – 6pm
*Select services only

ABOUT
EMERGENCY
SPECIALTIES
PET OWNERS
- Pay Online
- Testimonials
- FAQ
- Forms
VETERINARIANS
- Referring Veterinarian Partners
- Continuing Education
CONTACT US
Pay Online

Surgery & Orthopedics Patient History FormAustin Veterinary Team2020-12-14T12:50:13-06:00

Surgery & Orthopedics Patient History

Name*
First Last
Patient Name*
Date
MM slash DD slash YYYY
Why were you referred to our facility?
What symptoms have you observed at home?*
If your patient has a limp, abnormal gait, and/or behavior, do you have capabilities to provide an at home video?
- Yes
- No
If yes, are you able to e-mail the video to us avessurgery@austinvets.com?
- Yes
- No
When did the symptoms start?*
Are the symptoms:
- Progressing
- Staying the same
- Improving
Has your pet had or currently have any other medical conditions including hospitalizations and surgeries?"
What medications (if any) is your pet currently taking, including any supplements, over the counter medications, and preventatives?
If medications are being used to treat the condition for which we are evalutating your pet, have they been associated with any improvement in the condition?
Will you or your referring veterinarian be providing medical records?
- Self
- Referring Veterinarian
Have any radiographs (x-rays) been taken for this issue?
- Yes
- No
If yes, will you be bringing the radiographs with you or will they be provided by your referring veterinarian?
- Self
- Referring Veterinarian
Was an ultrasound performed for this issue?
- Yes
- No
If Yes, will you be bringing the ultrasound report with your or will it be provided by your referring veterinarian?
- Self
- Referring Veterinarian
Have any laboratory tests been performed, including bloodwork, cultures, cytology or histopathology?
- Yes
- No
If yes, please indicate which tests were performed
- bloodwork
- cultures
- cytology
- histopathology
What kind of food do you feed your pet?*
How much per day?*
Do you have other pets?
- Yes
- No
Do you have Pet Insurance?
- Yes
- No
If yes, which provider and what is your policy number?
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

CALL US TODAY AT

512-343-2837

EMERGENCY

OPEN

24/7/365

Have an emergency? We are open 24/7/365 for pets requiring immediate assistance.

MEET AVES

SPECIALTIES

REFERRALS

JOIN OUR TEAM

LOCATION

News

July Member Meeting & CE – Speaker TBD
High Flow Nasal Oxygen Therapy utilized for Non-Cardiogenic Pulmonary Edema in a Near Drowning episode – by Jami Becker DVM, DACVECC
FREE Continuing Education (CE) lecture in partnership with CAVMA
Total Hip Replacement – A Complete Information Guide – by Russell Kalis, DVM, DACVS-SA

Upcoming Events

July Member Meeting & CE – Speaker TBD
High Flow Nasal Oxygen Therapy utilized for Non-Cardiogenic Pulmonary Edema in a Near Drowning episode – by Jami Becker DVM, DACVECC
FREE Continuing Education (CE) lecture in partnership with CAVMA

Pay Online

We’ve made it safe and easy for you to pay your bill online.

More Information

7300 Ranch Rd 2222, Austin, TX 78730

Tel: 512-343-2837 Fax: 512-343-2844
Emergency Hours: 24/7/365
Specialty Hours: M – Sat: 8am – 6pm
Copyright 2019. All Rights Reserved.

Phone Number:

Request a Lecture

Hospital Name(Required)

Hospital Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Name(Required)

Contact Phone(Required)

Contact Email(Required)

Enter Email Confirm Email

Requested Lecture(s)(Required)

Preferred Format(Required)

Number of Attendees(Required)

Preferred Date Options(Required)

MM slash DD slash YYYY

(please allow 30 days lead time)

Other Comments

CAPTCHA