Appointment Questionnaire

Please fill out the below form before your pet's appointment:

Name
First Last
Pet Name
Phone number available during appointment*
Consent*
I have read the current protocols for appointments on the website
Consent*
I understand that I must have my pet on a securely tightened collar/harness and leash (not extendable leashes if possible please) or in a secure carrier.
Consent*
I will inform the staff if my pet has special needs. It is helpful for us to know if your pet is aggressive with other pets or humans. If your pet is fearful or anxious, we may be able to provide some anxiety medications in advance for you to give 1-2 hours before the appointment.
Consent*
I understand that it is recommended for me to bring a fresh stool sample in case it is needed.
Consent*
I understand that it is recommended for me to bring a fresh urine sample if my pet has any increased drinking, change in urination habits
Consent*
I consent to my pets photos being used for social media purposes.
What diet is your pet being fed (Brand, Type, flavour)?:
How much pet food does your pet get per day exactly (# cups)?:
Please list as precisely as possible all other treats, chews, table food that your pet gets in a day including amounts:
Please list any medications or supplements that your pet is taking (including strength, and frequency):
Has your pet been to another facility from which we should request records to complete his/her file?:
Does your pet travel outside of Kitchener (i.e. cottage)? If YES, where?:
Does your pet spend time outdoors, please describe where:
How much exercise does your pet get?
Has your pet had any vomiting? If YES, please describe (frequency, appearance etc):
Has your pet had any diarrhea? If YES, please describe (frequency, appearance etc):
Has your pet had coughing or sneezing or difficulty breathing?
Does your pet have any mobility concerns (difficulty with stairs, getting onto bed, getting into car)?:
Does your pet have any lumps/bumps that you would like the doctor to assess? If YES, please list their locations, size and how long they have been present.
Please list any other health concerns you have with your pet
Please don’t hesitate to call if you have any questions or concerns prior to your appointment. If you are unable to make your appointment, please give us 24 hours notice to cancel or reschedule so that we can accommodate another patient in your place.

Have a Question? Need to book an appointment?

Name: Gateway Pet Hospital
Address: 4391 King St E, Kitchener, ON, N2P 2G1, CA
Telephone: (519) 653-1003
Price range: $$

Connect with us and one of our team members will be happy to assist you.

Contact Us

4391 King St E
Kitchener, ON N2P 2G1

Ph: (519) 653-1003
Fx: (519) 653-1320

[email protected]

Hours of Operation

Monday 8:00am – 7:00pm

Tuesday 8:00am – 7:00pm

Wednesday 8:00am – 7:00pm

Thursday 8:00am – 7:00pm

Friday 8:00am – 7:00pm

Saturday 9:00am – 4:00p

Sundays Temporarily Closed

EMERGENCY HOURS

For all after-hours emergencies please call (519) 650-1617

Pet Emergency Make An Appointment