Non-Routine Appt. - Health Concern History

Eagan Pet Clinic

4395 Rahn Rd
Eagan, MN 55122

(651)454-5684

eaganpetclinic.com

Due to the COVID-19 pandemic, the majority of communication during appointments is now done over the phone.  To help expedite your check-in process, please fill out the following form.  Please note that we are experiencing longer than normal wait times, and as always, we are prioritizing patients experiencing emergency situations. 

Please call the clinic when you arrive for your appointment. Note that calls from Eagan Pet Clinic may show up as Blocked, Unknown, or Out of Area in your caller ID - you may not recognize the number and the number may not be 'local.'

Staff will not reach into your vehicle to retrieve your pet or open your car doors.  You are required to remove your pet from your vehicle and transfer him/her to a staff member as directed during your check-in phone call. 

For the safety of staff and other pet owners, please practice social distancing at all times.

If this if your first visit to EPC, please fill out a New Client form prior to your appointment.

If this is your pet's first visit to EPC, please ensure we receive their medical records prior to their appointment.  Records can be emailed or faxed.

Non-Routine Appt. - Health History Form

Date of Appointment: (required) :
Time of Appointment: (required)

Pet's name: (required)

Person's name the appointment is scheduled under: (required)

The State of Minnesota requires we screen clients for health issues related to COVID-19.
• Fever (100.4 F or higher), or feeling feverish?
• Chills?
• A new cough?
• Shortness of breath?
• A new sore throat?
• New muscle aches?
• New headache?
• New loss of smell or taste?
Are you or anyone in your household suffering from any of the above health symptoms that cannot be attributed to another health condition? Answering yes will not prevent your pet from receiving care. It will allow EPC to take extra precautions. (required)

Yes
No


Phone number we can reach you at during the appointment: (required)

Color, make, and model of vehicle you'll be in at your appointment: (required)

Reason for your pet's visit? (include symptoms, start/frequency of symptoms, and any other relevant information) (required)

Are there any behavioral concerns you'd like to address? If so, please explain.

If your pet is currently taking any medications, including supplements, please list the name of medication, dose and frequency:

Acknowledgement
Please call the clinic when you arrive for your appointment. Note that calls from Eagan Pet Clinic may show up as Blocked, Unknown, or Out of Area in your caller ID - you may not recognize the number and the number may not be 'local.'
Staff will not reach into your vehicle to retrieve your pet or open your car doors. You are required to remove your pet from your vehicle and transfer him/her to a staff member as directed during your check-in phone call.
While at Eagan Pet Clinic, for the safety of staff and other pet owners, please practice social distancing at all times.
By checking below, you acknowledge that you have read, understand, and will comply with the information contained on this page. (required)
Yes

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