(714) 847-1291
hbpetvets.staff@gmail.com


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Curbside Exam Form

Streamline your pet’s curbside examination with our convenient form, ensuring a smooth and safe experience.

Curbside Exam Form

Make your curbside exam hassle-free. Please complete the form accurately for a seamless experience.

Curbside Exam Form

Beach Blvd Pet Hospital Pet Exam Questionnaire

Date

Name *

First

Last

Email *

PS#

Anybody in household test + for Covid?

Yes
No

New Pet?

Yes
No

From where?

How long have you had?

Is your pet eating normally?

Yes
No

Diet

Raw Diet?

Yes
No

Grain Free?

Yes
No

Brand

Is your pet drinking normally?

Yes
No
More
Less

Are your pet’s stools normal?

Yes
No

Straining to defecate?

Yes
No

If not, is it diarrhea, soft, darker, bloody, mucous, smaller in size, worms-describe

Is your pet vomiting?

Yes
No

If yes, describe vomit?

How one time or multiple?

Last time vomited?

Is your pet coughing?

Yes
No

Dry/Productive

Duration

Exposed to sick dog?

Yes
No

Is your pet sneezing?

Yes
No

Discharge?

Describe

If yes to S or C

Exposure to candles?
Plug-ins?
Smoke?
Open windows?
A/C?
New plants or flowers?
Essential Oils?

Select all that apply

Is your pet scratching or biting?

Yes
No

New diet?
Treats?
Laundry detergent?
Bedding?

Select all that apply

If yes, where

Scale 1-10

Has your pet been losing weight?

Yes
No

Intentional?

Yes
No

Has your pet been gaining weight?

Yes
No

Is your pet’s activity level normal?

Yes
No

Does your pet have a bad odor?

Yes
No

If yes, location?

Is your pet breathing abnormally?

Yes
No

Duration

Is your pet limping?

Yes
No

Which limb?

Duration

NWB?

Yes
No

Does your pet have any growths?

Yes
No

Duration

Location

Is your pet on a monthly Flea & Tick Preventative?

Yes
No

Type?

Missed doses?

Yes
No

Is your pet on a monthly Heartworm Preventative?

Yes
No

Type?

Missed doses?

Yes
No

Any concerns you may have about your pet

Contact Name *

Message

We’re excited to meet you

Please call us at (714) 847-1291 or use the button below to make an appointment with us!

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Have Any Questions?

Please fill out the form below and a member of our team will get back to you shortly.



Contact

P: (714) 847-1291
E: hbpetvets.staff@gmail.com



Location

16191 Beach Blvd
Huntington Beach, CA 92647



Opening Hours

Mon-Fri: 8:00am – 6:00pm
Sat: 8:00am – 4:00pm
Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Phone

We proudly serve the pets of Huntington Beach, CA and beyond

Huntington Beach
Fountain Valley
Garden Grove
Westminster
Costa Mesa
Irvine

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