Veterinary care

New Client Intake Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Veterinary care

New Client Intake Form

Owner's First Name

Owner's Last Name

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Mobile Phone

Confirm Email

Pet's Name

Species

Breed (if known)

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex

Previous Veterinary Practice (if any)

Previous Veterinarian (if any)

Date of last vaccines (if known)

What vaccines were given at this time?

Is your pet on any medication or supplement?

Yes No

If Yes, please list the medication or supplement

Do you have a Pet Insurance?

Yes No

If Yes, Please specify the insurance provider name

What food does your pet eat?

Does your pet have allergies or drug reactions?

Yes No

If Yes, please list the allergies and reactions

Are there any current or past medical conditions of which we should be aware?

Yes No

If Yes, please comment on the condition(s) and indicate if they are current or past conditions

Please use the following box to give us any other relevant information about your pet

Veterinary care

New Client Intake Form

Veterinary care

New Client Intake Form

Contact Details

Service Area

Opening Hours

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