Diagnostic Imaging Services

×

Check in Form

Client name: *

Client primary phone number: *

Client secondary phone number:

Full client address (include postal code:) *

Client email address: *

Patient name: *

Species: *
CanineFelineOther

Breed: *

Colour: *

Patient age/birth date: *

Patient sex: *
MaleFemale

Has your pet been spayed or neutered *
YesNo

Health concerns today: *

What medications is your pet on? *

When was your pet last vaccinated? *

Is your pet on parasite prevention? If so, what? *

Has your pet travelled outside the province? If so, where? *

Does your pet have any allergies? *

Who is your family veterinarian? *

I authorize the staff at Trinity Hills 24 Hour Veterinary Hospital to use the following; Images and/or videos of my pet, my pets name/ medical conditions, on their social media platforms (Facebook, Instagram, and Tik Tok) *
YesNo

×

Reproduction Form

New reproduction service policy – As of December 19th 2022, we will only perform progesterone testing on females over 1 year of age. We do not collect or breed every dog that is presented to us as it is our goal to only partner in helping to create healthy puppies. We will require breed specific health testing according to your breed's parent club. Requirements for each breed can be found at www.ofa.org/browse-by-breed

Client Name *

Address *

Primary phone number *

Secondary phone number *

Email *

Dog Information

Call name *

Reg'd name *

Breed *

Date of Birth *

Sex *

Colour *

Microchip/Tattoo# *

Registration # *

Registry *
CKCAKCOther

Advise of all health testing performed *

I authorize the staff at Trinity Hills 24 Hour Veterinary Hospital to use the following; Images and/or videos of my pet, my pets name/ medical conditions, on their social media platforms (Facebook, Instagram, and Tik Tok) *
YesNo

×

Auto-History Form: Reproduction

We do not collect or breed every dog that is presented to us as it is our goal to only partner in helping to create healthy puppies. We will require breed specific health testing according to your breed's parent club. Requirements for each breed can be found at www.ofa.org/browse-by-breed

Owner name: *

Owner phone: *

Owner email: *

Patient name: *

Patient age/birth date: *

What are your concerns/questions today?: *

Breeding history: *
MaleFemale

Has she been bred before? When?: *

How was she bred previously? (natural, AI, TCI, surgical) (fresh, chilled, frozen): *

What were the previous progesterone levels?: *

What was the breeding date?: *

Was an ultrasound performed? When?: *

Did she have puppies?: *

Did she whelp naturally or C-section? Did she require oxytocin: *

Has his semen been evaluated?: *

Has he sired puppies (regardless of method of breeding)?: *

Has be bred naturally?: *

Has his semen been frozen? What were the results?: *

Has he achieved puppies with frozen semen?: *

Does he have a history of blood in the semen?: *

Does he strain to urinate?: *

Does he strain to defecate?: *

Is there any other medical history to be aware of?: *

Has your dog successfully completed their recommended breed specific health testing?: *

Has your dog been seen at another clinic for reproduction related reasons? If so, please explain?: *

Do you give permission for us to obtain their previous medical records? Please list veterinarian information: *

I authorize the staff at Trinity Hills 24 Hour Veterinary Hospital to use the following; Images and/or videos of my pet, my pets name/ medical conditions, on their social media platforms (Facebook, Instagram, and Tik Tok) *
YesNo

Abdominal and thoracic ultrasound – Hitachi Aloka Arietta 70

Computed tomography -Aquilion Prime

IDEXX ImageVue DR50 Digital Imaging System

We direct bill with trupanion insurance and can also assist you with other insurance company claims.

We also can provide you information on scratch pay which is a financing company that specializes in providing veterinary payment plans.

Get in Touch

Quick Links

Check in Form

Referral Form

Pet Information

Medical History

Internal Medicine History

History

What is your pet's diet?

Reproduction Form

Auto-History Form: Reproduction

Diagnostic Imaging Services

Abdominal and thoracic ultrasound – Hitachi Aloka Arietta 70

Computed tomography -Aquilion Prime

IDEXX ImageVue DR50 Digital Imaging System

We direct bill with trupanion insurance and can also assist you with other insurance company claims.

We also can provide you information on scratch pay which is a financing company that specializes in providing veterinary payment plans.

Get in Touch

Quick Links

Newsletter

Check in Form

Referral Form

Pet Information

Medical History

Internal Medicine History

History

What is your pet's diet?

Reproduction Form

Auto-History Form: Reproduction