"*" indicates required fields Patient Name:*Owner's Name:*Phone*Email* Internist (choose one): Dr. Carrie Goldkamp Dr. Eric Walsh How has your pet been doing since the last visit?How is your pet’s appetite?Is your pet exhibiting any of the following: Coughing Sneezing Vomiting Diarrhea Increased Thirst Decreased Thirst Increased Urination Decreased Urination If you checked any options above, please elaborate:Please confirm your pet’s current medications and dosing:Do you need any medication refills? If so, where would you like them filled?Are there any new concerns or things you would like addressed at this appointment?Directions*All patients (with the exception of diabetics) should have a 12-hour fast prior to recheck appointments unless otherwise directed. If you are unable to medicate your patient without a small bit of food, please contact the department for specific instructions (email: internalmedicine@lancasterpetemergency.com). I Agree CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
