Pre-Exam Questionnaire

WHEN YOU ARRIVE

Park at BHPH Only please.

Once you arrive please remain in your car. Send a text message to 203-324-5711 with the following information, as a single line of text:

  1. Your name and your pet’s name
  2. Color/make/model of your car and location
  3. For Doctor’s Exam: Name of Doctor you are scheduled to see  (Dr. Steven Zeide, Dr. Nolan Zeide, Dr. Alan Shanker, or Dr. Jessica Greenberg)
  4. Inside hospital or Zoom from car preference

Your Information

Appointment Information

Pet Information

(All non-Doctor exams and services remain fully curbside ONLY, at this time).

By selecting “I Accept” using any device, means or action, you consent to the legally binding terms and conditions of this Agreement and the Disclaimer. You further agree that your signature on this document (hereafter referred to as your “E-Signature”) is as valid as if you signed the document in writing.
reCAPTCHA is required.