• Email Us
  • (860) 668-4041
  • Directions
  • Pet Portal

Suffield Veterinary Hospital

  • Email Us
  • (860) 668-4041
  • Directions
  • Pet Portal
Menu
  • Home
  • About
    • Our Doctors
    • Live Tour
    • Who We Recommend
    • Careers
  • Clients
    • Online Store
    • New Clients
    • New Patient
    • New Breeding Client
    • Appointments
    • Online Forms
    • Poison Control
    • Articles
  • Patient of the Month
    • Patient of the Month
    • Pets of the Month Archive
  • Services
    • Emergency
    • Wellness Exams
    • Vaccinations
    • Dentistry
    • Surgery
    • Reproduction
    • Exotics
  • Contact

Avian and Small Mammal History Form

MM slash DD slash YYYY
Which phone number should we use to contact you today?

If appropriate, would you prefer us to contact you via text message?
Do you have Pet Insurance?
From what source did you acquire it?

What do you feed your pet? (Please be specific.)
Food
How Much?
How Often?
 
Has your pet eaten today?
Does your pet go outside?
Do you give any supplements?
If “Yes”
Does your pet appear to have any problems?
Has your pet had any previous illnesses?
Has your pet received any medication(s) recently?
Have there been any recent changes in the pet's environment?
Has your pet's appetite changed in any way?
Has there been any change in the color or consistency of the pet's droppings/stool?
Have you noticed any signs of respiratory problems?
Have you noticed any regurgitation?
Does your pet have any cage mates?
If “Yes”: Are the cage mates showing any signs of illness?
Have any new pets been added to your aviary or household?

Birds

Have you noticed any regurgitation?
Has your bird been exposed to any other birds including wild birds? (e.g. boarding, pet shop, etc.)

Small Mammal

Does your pet have any allergies or vaccine reactions?
Do you use any flea/tick preventative?

Diagnostics and Treatment Consent

I hereby authorize Suffield Veterinary Hospital to perform professional services that are, in their opinion, advised for treatment and maintenance of my pet’s health and wellbeing.
I also authorize the following, if necessary, to be performed:

Website and Social Media Release

I hereby grant Suffield Veterinary Hospital permission to use the likeness of my pets (s), should they so choose, in a photograph, video, or other digital reproduction in any and all of its publications, including website and social media entries, without payment, compensation, or any other consideration. I understand and agree that these materials will become the sole property of Suffield Veterinary Hospital. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my pet’s likeness appears.
Clear Signature

After Hours Pick-Up Policy

Please note our business hours and make sure to pick up your pet prior to closing. If you pick up your pet after we close, you will be charged a late pick up fee of $50.00. If you are more than 30 minutes late, your pet will stay overnight at SVH and an appropriate overnight charge will be added to your invoice, in addition to the $50.00 late fee.

Payment for Products, Medications and Services Rendered

I understand that the invoice resulting from my pet’s admission to Suffield Veterinary Hospital is to be paid in full at the time my pet is discharged from Suffield Veterinary Hospital. I will satisfy payment via the following method:
Clear Signature

I am the owner or agent of the aforementioned pet, am at least 18 years of age, and am competent to contract in my own name. I have read this document in its entirety before signing below and I fully understand all of the content in this document and its meaning. I fully understand the impact of signing this release.

Clear Signature
MM slash DD slash YYYY

Office Hours:

  • MON: 7:30am – 6:00pm
  • TUE: 7:30am – 6:00pm
  • WED: 7:30am – 5:00pm
  • THU: 7:30am – 6:00pm
  • FRI: 7:30am – 5:00pm
  • SAT: 8:00am – 1:00pm
  • SUN: CLOSED
Call Us: (860) 668-4041

Our Veterinary Office

577 East St. South
Suffield, CT 06078

Request an Appointment

  • Appointment requests are for existing clients only. If you are enquiring about a new client appointment, please click here.

    Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Like Us On Facebook




Suffield Veterinary Hospital

Our Location

Suffield Veterinary Hospital

Phone: (860) 668-4041 Address: 577 East Street S, Suffield, CT 06078 | Fax: (860) 668-4785

Sitemap | Accessibility | Website by DOCTOR Multimedia
Accessibility by WAH
  • About
  • Accessibility
  • Appointments
  • Careers
  • Client Links
  • Contact
  • Dental Admit Form
  • Emergency
  • Home
  • New Breeding Client Form
  • New Clients
  • New Patient
  • Newsletter
  • Our Doctors
  • Patient of the Month
  • Pets of the Month Archive
  • Services
    • Emergency
    • Wellness Exams
    • Vaccinations
    • Dentistry
    • Surgery
    • Reproduction
    • Exotics
  • Sitemap
  • Specials
  • test
  • Thank You
  • Live Tour
  • Online Forms
    • Avian and Small Mammal History Form
    • Behavior Consult Questionnaire
    • New Breeding Client
    • New Client Request Form
    • New Client Request Form (Breeding)
    • OFA Hip and Elbow Dysplasia Form
    • Pre-Examination History and Consent Form
    • Small Mammal Pre-Examination Checklist
  • Who We Recommend
  • MM slash DD slash YYYY
  • If so, please indicate new information below

  • Drop files here or
    Max. file size: 256 MB.
    • NameSpeciesBreedDate of Birth/AgeColor 
    • This field is for validation purposes and should be left unchanged.
    Call Us