Curbside Care | Clayton Veterinary

Churchtown Veterinary: (856) 678-3883

Due to COVID-19 we are currently not able to allow fellow humans into our buildings while we care for their pets. Please fill out this form so we can make sure we have your current contact information and understand why you are bringing your pet in to see us.

When you arrive at our office, we ask that you call us to check in. Our receptionists will get your chart ready and a technician will talk to you on the phone before coming out to get your pet. You will have an opportunity to talk to the doctor on the phone during your appointment.

Note: This form is for pet parents who already have an appointment scheduled – If you have not yet scheduled your appointment, please call us at 856-881-7470 to schedule before doing this form. Thank you!

Appointment Information

Date *

Time *

Location *

Clayton (820 North Delsea Drive, Clayton NJ)

Churchtown (296 North Broadway, Pennsville NJ)

What is the best number to reach you at during your appointment?

Due to COVID-19, we are currently asking owners to remain in their vehicles during the appointment. Please provide us with the best number for our doctors and technicians to reach you during the appointment. If you do not have a cell phone you may leave this blank.

Owner's Information

Name *

Street Address *

Country

City

State

Zip code

Primary Phone # *

Pet Information

Pet's Name *

Species *

Dog

Cat

Breed (if known)

Color *

Date of Birth or Age (if known)

Reason For Visit

Why is your pet coming to see us today? *

Will you need any medication refilled at your appointment?

You can also ask for heartworm prevention or flea/tick prevention if needed.

If your pet is sick, how long has the issue been going on?

Is your pet currently taking any medications or supplements? *

Yes

If "yes", please list the medications / supplements your pet is taking.

What are you currently feeding your pet?

How is your pet's appetite? Are they eating more or less than normal? *

Normal / No changes

Eating MORE than usual

Eating LESS than usual

I'm not sure

Has your pet recently lost or gained weight? *

Yes, gained weight

Yes, lost weight

I'm not sure

Any coughing or sneezing? *

Yes, coughing

Yes, sneezing

Yes, coughing and sneezing

Any vomiting or diarrhea? *

Yes, vomiting

Yes, diarrhea

Yes, vomiting and diarrhea

Have they gotten into anything? Eaten anything unusual? *

Yes

I'm not sure

For Cats Only: Is your cat an indoor or outdoor cat?

Indoor only

Mostly indoor, goes outdoors sometimes

Indoor / Outdoor

Outdoors most or all of the time

Any recent environmental changes?

Is your pet drinking more or less than normal? *

Yes, drinking MORE

Yes, drinking LESS

I'm not sure

Any changes to their urination? *

Yes, urinating MORE

Yes, urinating LESS

I'm not sure

How are their bowel movements? *

Normal

Abnormal - softer than normal / diarrhea

Abnormal - harder than normal / seems constipated

When was their last bowel movement (if known)?

Any additional comments or notes?

Captcha *

reCAPTCHA Public Key not found. Both Public and Private keys must be set in order for reCAPTCHA to function.

Learn how you can become a client

We invite you and your best friend to join us at Clayton and Churchtown Veterinary. Call (856) 881-7470 to learn how you can become a client and to schedule your appointment.

Call Now (856) 881-7470

COVID-19 - Curbside Care Form

Appointment Information

Owner's Information

Pet Information

Reason For Visit

Learn how you can become a client