Call 520.886.1125

180 N. Harrison Road
Tucson, AZ 85748 Map It
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HOURS
Mon-Fri 7:30am-5:30pm
Sat 9:00am-4:00pm
  • Home
  • Services
    • Comprehensive Physical Exam (more than a brief glance!)
    • Wellness Packages
    • Individualized Preventive Care
    • Pet Dental Care with Radiographs!
    • Safer Surgery
    • Behavior Therapy
  • Our Team
  • Appointments
    • Request an Appointment
    • Patient Forms
      • New Patient Registration
      • Prescription Request
      • Medical History Form
      • DROP OFF CHECK-IN CONSENT
      • CURBSIDE CHECK-IN FORM
      • SURGICAL/ ANESTHETIC CONSENT
      • Telemed Consult Form
      • DENTAL TREATMENT CONSENT FORM
      • Health Certificate Info
  • Blog
    • Telehealth Consults for Pets- Cimarron Animal Hospital
    • Curbside Check In and Telehealth Exams – Cimarron’s New Services
  • Pet Resources
  • Contact
  • Home
  • Services
    • Comprehensive Physical Exam (more than a brief glance!)
    • Wellness Packages
    • Individualized Preventive Care
    • Pet Dental Care with Radiographs!
    • Safer Surgery
    • Behavior Therapy
  • Our Team
  • Appointments
    • Request an Appointment
    • Patient Forms
      • New Patient Registration
      • Prescription Request
      • Medical History Form
      • DROP OFF CHECK-IN CONSENT
      • CURBSIDE CHECK-IN FORM
      • SURGICAL/ ANESTHETIC CONSENT
      • Telemed Consult Form
      • DENTAL TREATMENT CONSENT FORM
      • Health Certificate Info
  • Blog
    • Telehealth Consults for Pets- Cimarron Animal Hospital
    • Curbside Check In and Telehealth Exams – Cimarron’s New Services
  • Pet Resources
  • Contact

TeleMed Consult

Medical History Questionnaire
  • Date Format: MM slash DD slash YYYY
  • ** Special (temporary) Gubernatorial COVID-19 Order allows veterinarians to establish a Veterinary-Patient-Client Relationship via electronic means. A "Veterinary-Client-Patient Relationship" usually requires an in-person knowledge of the patient's physical condition as well as a knowledge of how it is cared for in its environment, requiring an in person doctor examination within the year. If we have not seen your pet in person within the year, we may still be able to assist. If we cannot, our Doctor may recommend an in-clinic examination to adequately care for your pet. Please submit this form and we will try to help as expeditiously as possible.
  • MEDICAL HISTORY

    Please fill in the health questions below so we can be sure to cover everything while your pet is here. This also helps us keep your pet's record up to date between visits!
    Please check all that apply
  • Please describe Cage/ Enclosure Bedding How much is he/ she allowed to roam around the house? Access to outside? Other cagemates?
  • Remember Heartworm Preventives, Flea/Tick Protection, Vitamins and Natural supplements
  • Telemedicine Consult Limitations

    I Understand that: This Telehealth consult will not be as thorough as an exam in person. There is a fee of $25 upon completion of the Telehealth consult. This fee is not refundable. However, If it is determined, during this consult, that my pet cannot be sufficiently treated without an exam in-clinic, the amount of the Telemedicine consult fee will be applied to the in-clinic exam when it occurs. (If my pet is not presented in-clinic for the issue after recommendation by the veterinarian, no credit or refund will be provided.) If this consult is interrupted due to technological difficulties, it will be restarted. Other team members may be within hearing of this consultation during video Ccnferencing. These people will all maintain confidentiality of any information overheard. However, if, at any time, you would like more privacy, we will accommodate. For Emergency consultations where our doctors do not have a Veterinary-Client-Patient Relationship, we will forward records of this consult to your regular veterinarian. If you have any additional questions about the Telemedicine consult process, please call our office at 520 886-1125
  • By typing my name below I agree to the terms of the Telelmedicine Consult Limitations described above.

For Emergency Pet Care After Hours, Please Call (520) 886-1125

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