New Patient Information

Thank you for giving us the opportunity to care for your pet. To insure the best care possible, please take the time to fill this form completely.

*Please be sure to fill out all required fields and that after submitting the form, you receive the message that the form was successfully submitted

We pride ourselves on tailoring the medicine we provide to the lifestyle of your pet. Please note: **State and federal law require this form to be completed by a person over the age of 18**

Client / Owner Information
Spouse / Co-Owner Information
Marketing
Doctor Referral
If you have been referred to us by another veterinarian, please provide their information below.
Pet Health History
Type of Pet
Vaccinations up to date? **Please provide vaccine history
Please Mark Yes or No Regarding Your Pet
Any known allergies?
Take any medication?
On year round flea / tick preventative?
On year round Heartworm Preventative?
Around pet's other than yours?
Around Children?
Been microchipped?
Swim in lakes/streams/pool?
Go hiking or camping?
Please Check Any That Apply To Your Pet
Scratching
Coughing
Weakness
Painful/Stiff
Nervous
Bad breath
Behavior problems
Loss of appetite
Weight gain/loss
Change in defecation
Change in urination
Itching
Vomiting
Scooting
Increased thirst
Changes in breathing
Please Check Any Services You May Utilize
Authorization
To help prevent the spread of infectious disease, all pets with fleas will be given flea treatment at the owner's expense. All admitted pets must be current on all vaccines. DUE TO STATE LAW AND INSURANCE REQUIREMENTS all dogs and cats must be current on Rabies Vaccination. Vaccinations can be updated at the time of your appointment.
I hereby authorize the veterinarian to examine, prescribe or treat the above described pet. I assume full responsibility for all charges incurred in the care of this pet. I understand that charges must be paid in full at the time of release unless approved payment arrangements are made in advance and any treatments may require a deposit.