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4176 Meridian Street

Bellingham, WA 98226

(360) 758-2200

24/7 Emergency Care

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Services
About
Referral Requests
- Vet Referrals
Pharmacy
Registration
Contact

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Medical History Oncology Initial Form

Medical History: Oncology Initial (Bellingham)

4176 Meridian St, Bellingham, WA 98226 | Phone: 360-982-0166 | FAX: 1-888-867-6928 | bbvsh.com/bellingham | bellingham@bbvsh.com
Health Check
During the COVID-19 outbreak, the health and safety of our clients, patients, employees, doctors and our community is paramount.
Have you travelled to any countries outside the United States (including Canada) within the last 14 days?*

YesNo
Did you provide care or have close contact with a person with COVID-19 (probable or confirmed) while they were ill (cough, fever, sneezing, or sore throat) within the last 14 days?*

YesNo
Did you have close contact with a person who travelled outside of the United States in the last 14 days who has become ill (cough, fever, sneezing, or sore throat)?*

YesNo
Have you or anybody in your home had contact with someone who is being tested for COVID-19 or who has been diagnosed with COVID-19?*

YesNo
Contact Information
Your name*
Your email
Optional: If you enter in your email, we will send you a copy of this form to you.
Phone number where you can be reached today
(XXX) XXX-XXXX
Your pet's name*
What is your primary concern today?*
Reason for visit
When did you first notice the problem?*
How has it progressed? Has it gotten significantly worse?*
Which tests have been performed?*

BiopsyCytologyNeither
Does your pet have any other major illnesses of which we should be aware? *
Is your pet currently experiencing any of the following symptoms?
Difficulty breathing?*

YesNo
Collapse?*

YesNo
How many collapse episodes have occurred?