608-835-0551 customerservice@countryviewvets.com

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1350 S Fish Hatchery Rd. Oregon, WI 53575

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Intake Form

Species: *

Canine
Feline

Pet Name: *

Owners Name: *

Email: *

Contact Number: *

Reason for Visit: *

Diet:

Brand of Food:

How Much:

How Often:

Is Your Animal Eating, Drinking, Urinating, and Defecating Normally? *

Yes
No

If No, Explain:

Is Your Animal Coughing, Sneezing, Vomiting, or Having Diarrhea? *

Yes
No

If Yes, Explain:

How is Your Pets Energy Level at Home? *

Normal
Abnormal

If Abnormal, Explain:

Is Your Pet on Any Medications or Supplements? *

Yes
No

If Yes, Please List Name, Dosage and Frequency:

Is Your Pet on a Heartworm Preventative? *

Yes
No

If Yes, What Kind and When Was it Last Given:

Is Your Pet on a Flea/Tick Preventative? *

Yes
No

If Yes, What Kind and When Was it Last Given:

Are There Other Pets in Your Household? *

Yes
No

If Yes, Please List

Does Your Pet go to Daycare/Dog Parks or Boarding? *

Yes
No

Book An Appointment

At Country View Veterinary Service of Oregon, we want to be welcoming to people and their pets. We pay attention to your pets’ needs, and understanding your concerns are significant. Please book an appointment for your pet using our online system.

Book Appointment

Have a question?

Get in touch! Complete our online form and we will be in touch with you shortly.

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Location

1350 S Fish Hatchery Rd.
Oregon, WI 53575

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Contact Information

P: 608-835-0551
E: customerservice@countryviewvets.com

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Hours

Mon-Fri: 8:00 AM – 6:00 PM
Sat: 8:00 AM – 2:00 PM
Sun: Closed

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