Telemedicine – Growth/Mass Consult – Prairie Animal Hospital

Please complete this form prior to your scheduled telemedicine appointment.

We request you have pictures of the growths also ready to submit during the appointment.

Please enter Your Name: *

First

Last

What is your Pet's Name? *

What is the phone number we have on file?

What is the email address we have on file? (Note: Email on file must match the email on the PAH app in order to utilize the chat function) *

Where on your pet have you noticed the growth(s)? *

How long have the growth(s) been there? *

Has the growth changed since it was first noticed? (Please note any change in size, color, texture, discharge). *

Does the size of the growth seem to wax and wane? *

Is the growth bothering your pet? (i.e. are they chewing/licking/scratching rubbing at it or near the area where it is located?) *

If you answered yes to the previous question, have any previous growths ever had a fine needle aspirate/cytology or histopathology performed? What were the results?

Is your pet on any medications/supplements? If so, please list them: *

By submitting this form, I give my consent to the staff and doctors at Prairie Animal Hospital to discuss my pet’s medical concerns on the PAH app as a telemedicine appointment. I acknowledge that not all concerns can be addressed using digital resources and I may still have to bring my pet in for an in-person physical exam as may be recommended by the veterinarian during the telemedicine appointment. *

I consent

Website