704-827-5300
reception1@eastlincolnanimal.com
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Sick Patient Form

Save time during your next appointment! Complete your required sick patient form online from any device at any time before your visit.

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Sick Patient Form

Before your appointment, please complete this form as thoroughly and correctly as you can
so that we may get to know you and your pet(s).

Patient's Name *

Patient's Species *

Canine
Feline
Other

If 'Other', please specify: *

Owner's Name *

First

Last

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

Patient's Energy Level

Normal
Increased
Decreased

Please list the medications your pet is currently taking:

Do you need refills of any of these medications?

If you need a medication refill, please list which medications:

Do you need refills on any prescription pet food?

If you need a prescription pet food refill, please let us know which kind:

Patient's Appetite

Normal
Increased
Decreased

Drinking/Water Intake

Normal
Increased
Decreased

Is the patient coughing?

If yes, for how long?

Is the patient sneezing?

If yes, for how long?

Is the patient vomiting?

If yes, for how long?

Please upload any relevant records or photos below:

Click or drag files to this area to upload. You can upload up to 5 files.

Name

REQUEST AN APPOINTMENT

We look forward to seeing you and your pet!
Request an appointment by clicking the button below.

Call us

Have a question?

If you need anything for your pet, please use the information below to contact us.
A member of our team will be in touch soon!

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Location

7555 Hwy 73 E
Denver, NC 28037

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Contact Information

Phone: 704-827-5300
Email: reception1@eastlincolnanimal.com

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Hours

Monday-Friday: 8 AM – 5 PM
Saturday: Closed
Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

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