Curbside Check-In " Complete your form online! Please fill this form out before your visit. If you need immediate assistance, please call our team directly at 217-324-3311. Please enable JavaScript in your browser to complete this form.I am in this vehicle: *(please list model & color)Best Phone number for today's appointment: *Patient's Name *Patient's Species *CanineFelineOwner's Name *FirstLastAppointment Date/Time *DateTimePrimary Reason for Appointment / Concern (please be as detailed as possible) *Patient's Energy LevelNormalIncreasedDecreasedList Medications your pet is currently taking Do you need refills of any of these medicationsYesNoIf you need a medication refill, please list which medicationsDo you need refills on any prescription pet food?YesNoIf you need a prescription pet food refill, please let us know which kindPatient's AppetiteNormalIncreasedDecreasedDrinking / Water IntakeNormalIncreasedDecreasedIs the patient coughing?YesNoIf yes, for how long?Is the patient sneezing? YesNoIs the patient vomiting? YesNoIf yes, for how long?Please upload any relevant photos / videos / records here Click or drag files to this area to upload. You can upload up to 5 files. Owner's Signature *Clear SignaturePhoneSubmit