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We’re still open despite the construction out front! Contact us for any assistance.

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Corbin Animal Health & Wellness

Patient Drop-Off Form

Please complete this form as completely and accurately as possible so that we can get to know you and your pet(s) prior to your appointment.

Patient Drop-Off Form

Client Name *

First

Last

Phone number to reach you today *

Pet's Name *

Breed *

Gender *

When was your pet’s last meal? *

What did they eat? *

What mediations (If any) has your pet received in the last 24 hours?

Is your pet sensitive or allergic to any medications or food?

Yes
No

If yes, please list

My pet is lethargic

Yes
No

If yes, how long?

Water intake has

Increased
Decreased
Not changed

My pet has been vomiting

Yes
No

If yes, please provide details of when it started, the last time, and how many times a day

My pet has

Normal stool
Seems constipated
Diarrhea

Provide details

Has your pet had access to foods other than his normal diet? *

Yes
No

If so what could your pet gotten into

My pet has

gained
lost
no weight change

My pet is

Lame
Sore
Has been injured

The problem has

Worsen
Improved

The problem has

Never happened before
Been occurring a long time

Please describe the problem(s) your pet is having, pertinent history leading up to the current condition, any previous major medical problems, and what you would like us to do below:

Would you like us to perform diagnostic test

Yes
No

(If so what diagnostic test would you okay and the doctor will only perform the ones them think are necessary.) Taxes not included

Blood work $207
Fecal $28
Feline FeLV/FIV $51
ParvoTest $51
4dx (heartworm/E. Canis/lyme/anaplamosis) $48
Ear cytology $25
Skin cytology $20
Nail trim $19
Feline vaccines $94
Canine vaccines only $104.40
Canine vaccine w/ Fecal&4dx $162

Call or text me withfindings of the examination with estimate of diagnostics before performing any diagnostic test

Call
Text

Is there anyone in the household that has a peanut allergy that would require us to not potentially use peanut butter during an exam to make a pet focused?

Yes
No

Doctor or technician will call with potential treatment and findings after diagnostic test have been performed.

I accept financial responsibility for charges incurred for this pet

Signature *

(must be 18 years or older)

Date *

Name

Ready for a visit?

Corbin Animal Health & Wellness offers pet wellness care, pet dental care, diagnostic testing, surgery, senior pet care and pain management, hospice and euthanasia, and pet boarding in Corbin, North Corbin, Laurel County, London, Barbourville, Williamsburg, Hopewell, Lily, and the surrounding areas. Easily request an appointment for your pet using our online system on PetDesk. We look forward to meeting you and your furry family members!

We’re here to help.

To learn more about our clinic and services or to schedule your companion’s first appointment, please reach out to us today.

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Our Location

944 Cumberland Gap Pkwy
Corbin, KY 40701

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How to Reach Us

606-528-1744 (phone)
606-528-3389 (fax)
…or email us

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Our Hours

Mon–Fri: 8:00 am – 5:00 pm
Closed on Saturday & Sunday

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First

Last

Email *

Phone

How can we help you? *

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