Telemedicine – Progress Exam Consult Please complete this form prior to your scheduled telemedicine appointment. Please enable JavaScript in your browser to complete this form.Please enter Your Name: *FirstLastWhat 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) *Has the condition improved, worsened, or remained the same since your pet was last examined? *ImprovedWorsenedRemained the SameHave you been able to consistently administer any medications/diets as prescribed? *YesNoHas your pet been wearing their ecollar (if applicable)?YesNoHow has your pet’s behavior at home been? *Back to NormalLethargicAnxiousPainfulDepressedWhat medications/supplements is your pet currently taking: *What other pertinent information would you like the doctor to be aware of?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 consentNameSubmit