Rye Harrison Veterinary Hospital

Curbside Reason For Visit Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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Reason for Visit/ Drop off Appointment form

Client & Pet Information:
Please help us locate you in our system by providing the information below.

Contact Name *
First Name
Last Name
Contact Address (please update if you address has recently changed)
Address 1
Address 2
City
State / Province
Zip / Postal Code
Contact Email Address *
Pet Name *
Species and Breed

Curbside Reason for Visit & Pet Information:
Please share your reason for visit today as well as some important information about your pet's health.

What brings you in today? *
What does your pet normally eat?
Is your pet current on vaccinations? *
Is your pet currently taking any medications? If yes, please let us know what medications they are taking.
Do you need any refills of Heartworm prevention, Flea and tick prevention or other medications today? Please list below:
Is your pet experiencing any of the following? *
If yes please describe
What other concerns do you have?

Please provide the best way to contact you after your pet's exam. We will call to discuss exam findings. 

Contact Phone Number *
Signature *
Use your mouse or finger to draw your signature above
Clear
Today's date *
Date

Join the Rye Harrison Veterinary Hospital Family Today!

Located off of Exit 19 on I-95 (New England Thruway) between Theodore Fremd Ave and Maple Ave.

Phone: 914-921-2000

  • Monday: 8:00 am - 8:00 pm
  • Tuesday: 8:00 am - 8:00 pm
  • Wednesday: 8:00 am - 5:30 pm
  • Thursday: 8:00 am - 8:00 pm
  • Friday: 8:00 am - 5:30 pm
  • Saturday: 8:00 am - 1:00 pm
  • Sunday: Closed

If you are experiencing an emergency after hours, please call us at 914-921-2000 and you will be directed to the after hours support.

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