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New Patient (Pet) Form

Please fill out this form for each new pet.

Pet's Name*



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Birthdate or estimate*

Are you planning to spay or neuter your pet, if not already done?

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If not planning to spay or neuter, are you planning to breed your pet?

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How long have you owned this pet? Where did you get him/her?

Is your pet microchipped?

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How much time is spent outside?

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What brand of food does your pet eat? Canned, dry, or pouch? Table scraps?

How do you view your pet, in terms of overall health and wellness?*

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Previous veterinary clinic?

Any treatments for illnesses or health issues in the past? Please explain.

Is your pet currently taking heartworm preventative?

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Is your pet currently on flea control?

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Please list any other medications your pet may be taking (including supplements).

Please list any allergies (foods, drugs) that your pet may have.

Any additional information we might need on you or your pet?

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