Maine’s Only VECCS Level 1 Facility

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Appointment

Internal Medicine Questionnaire

Save time during your upcoming appointment! Before your arrival, fill out the necessary documents online at any time from any device.

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MVMC No-Show Policy

The health and well-being of our patients is our number one priority at Maine Veterinary Medical Center (MVMC) and we pride ourselves on our ability to see your pet in a timely manner. We understand that at times, unforeseen circumstances may arise, resulting in the inability to keep a scheduled appointment, however, in this instance we request you inform our office as soon as possible so that we may offer that spot to another patient in need. In the event you do need to cancel an appointment, we will happily reschedule you for our next available appointment slot with the applicable specialist. In the interest of fairness to both you and our staff, if you do not show up for two consecutively scheduled appointments or cancel these appointments in less than 48 hours of the appointment time, you will be asked to pre-pay the consultation fee prior to scheduling a third time.

Owner Name *

Patient Name *

Best contact number *

Email *

What are your goals for today? *

What is your pet’s current problem? *

When was your pet last normal? *

Has your pet ever traveled outside of the state? *

If yes, please list other states/countries visited and when? *

Where did you obtain your pet (shelter/breeder/stray/other) and at what age? *

For feline patients, please select one *

Indoor only
Outdoor only
Indoor/Outdoor

What do you feed your pet currently? Please be as specific as possible and include amount if known *

Other than the problem listed above, please list other current or past medical problems or surgeries:

When was your pet last vaccinated? *

Are vaccines up to date? *

Do you use any flea, tick or heartworm preventative? *

If yes, what product(s) do you use and when were they last given? *

Has your pet (if female) ever been pregnant in the past? *

Yes
No
Unsure

Has your pet had a transfusion of blood products in the past? *

Yes
No
Unsure

Do you have other pets at home? *

If yes, what species and how many? *

Is your pet fasted for the appointment (no food for 12 hours)? *

Please list any current medications (including over the counter medications, nutritional supplements and herbal medications).

Drug name, Dose (mg), How Often, When Started, Given Today?

Please list any other drugs or supplements given in the past month but not given currently (including over the counter drugs)

Has your pet exhibited any of the following signs?

Vomiting *

Diarrhea *

Weight gain *

Weight loss *

Seizures *

Limping *

Pain *

Coughing *

Gagging/retching *

Increased sneezing *

Abnormal breathing *

Decreased activity *

Urination abnormalities *

Appetite *

Decreased
Increased
Normal

Drinking *

Decreased
Increased
Normal

Urination amount *

Decreased
Increased
Normal

Frequency of urination *

Decreased
Increased
Normal

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Request Your Consultation

Please call (207) 885-1290 to book a consultation.

Do you think your pet may have ingested something poisonous? Please call the ASPCA Animal Poison Control Center at 888-426-4435.

Note: A consultation fee may apply.

Contact Maine Veterinary Medical Center

We would love to hear from you! You can complete the below form for general questions or comments.



Address

1500 Technology Way
Scarborough, ME 04074

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Phone

207-885-1290

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Email

reception@mvmc.vet

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Hours

Open 24/7

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Last

Email *

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How can we help you? *

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