Request an Appointment 606-248-4243 Check-in

2525 HWY 25E | Middlesboro, KY 40965

606-248-4243

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Curbside Appointment Check-In

Owner's Name*
First Last
Pet's Name*
Parking Spot / Car Description*
Please select all that apply.*
- I have been experiencing cold/flu symptoms.
- I have traveled out of the country in the last 30 days.
- I have been exposed to COVID-19 or someone with it.
- None of the above
- Other
Other*
Phone Number to be reached at for today's visit*
The reason for your visit:
- Vaccines / Annual Wellness Exam
- Exam
- Recheck
- Tech appointment
- Medication / Food Pick-up
- Other
Other*
Tech Appointment Questions
Has your pet been eating and drinking like normal?*
- Yes
- No
Please explain and state when you noticed a change*
Has your pet experienced any diarrhea or vomiting?*
- Yes
- No
please explain and state when it began.*
While my pet is here I would like the following done, if possible. (Select all that apply).*
- All vaccines that are due
- Only select ones, regardless of what is due
- Bloodwork that is due (ex, heartworm blood test, thyroid panel, glucose check, etc)
- Fecal Sample
- Nail Trim
- Anal Gland Expression
- Other
Other*
While my pet is here I approve any of the following recommendations that may be suggested by the veterinarian to treat/diagnose my pet. (Select all that apply)*
- X-rays
- Ear Cytology
- Ear Cleaning / Flush
- Fine Needle Aspiration
- Subcutaneous Fluids
- Urinalysis / Cysto(urine collection)
- Skin Cytology / Scrapping
- Recommended Bloodwork
- Anal Gland Expression
- Nail Trim
- Anything Necessary
- Nothing – Call 1st to discuss (understand it may slow down the process)
- Other
Other*
Is there anything we should keep in mind when working with your pet? Ex. Doesn't like men, deaf, blind, dog aggressive…*
Please answer all of the following questions.
Does your pet need any medication refills? Example: Heartgard/Simparica/Rimadyl.*
Please include how many months supple of each medication you would like.
Are there any other questions or concerns regarding your pet?
Are we able to e-mail you a copy of your invoice when your visit is complete?*
- Yes, I will enter my e-mail below
- No, I prefer a paper copy
Email*
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Bell County Animal Clinic

2525 HWY 25E

Middlesboro, KY 40965

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Bell County Animal Clinic

2525 HWY 25E
Middlesboro, KY 40965

Hours

MON – FRI: 8am – 6pm
SAT: 8:30am – 12:30pm
SUN: Closed

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