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Canine or Feline New Patient Information
Getting to Know Your Pet
Species
*
Canine (Dog)
Feline (Cat)
Patient Name
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Owner Name
*
First
Last
Nickname (if applicable)
From where and when did you acquire this animal?
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Date of Birth (if known)
*
Age (or approximate)
*
Gender
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Male
Female
Spayed (Females)
Neutered (Males)
Breed
*
Is your pet
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Purebred
Mixed
Unknown
Color and Markings
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Previous Veterinarian
Has this animal previously been to a veterinarian?
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Yes
No
Last Visit (or approx.)
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Name and Location (city, state) of Previous Veterinary Hospital(s) and Veterinarian(s) (if specific):
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Do you have copies of your pet’s full medical record? (If yes, please email copies prior to appt.)
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Yes
No
May we contact your previous veterinarian to get your records transferred?
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Yes
No
Medical History
List any relevant medical conditions that your pet was PREVIOUSLY treated for but is no longer receiving treatment. This may include conditions such as surgeries, injuries, or illnesses that do not require lifetime therapy.
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List any CURRENT diseases or diagnoses that your pet has and is being treated for.
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List any medications or supplements that your pet is currently being given, including dose, frequency, and length of treatment. Please also include supplements such as vitamins, glucosamine. (Ex: carprofen 25mg, 1/2 tablet morning and night, has been taking intermittently since February 2011):
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Please BRIEFLY describe any additional concerns that you would like to specifically address during your visit.
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Has your pet ever had a severe allergic reaction?
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Yes
No
If yes, please describe
Home Life
What is the primary purpose of this pet?
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Companion to Humans
Companion for Other Pet(s)
Protection of Person/Property
Service Animal
Emotional Support
None
Where does this pet spend their time?
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Completely Indoor
Mostly Indoor
Mix Indoor/Outdoor
Mostly Outdoor
Completely Outdoor
Approximate number of hours spent outside daily
*
What is your pet’s average activity level?
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Highly Active (hiking, running, working, swimming, long periods of play, an hour or more daily)
Moderately Active (frequent walks, running errands with family, daily play time, between 30 min to 1 hr daily)
Lightly Active (occasional walks, play times, less than 30 min daily)
Couch Potato (as little activity as possible)
What other pet(s) are in the home? Does this pet have any interaction with the others?
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Food and Diet
What does this animal eat? (Check all that apply):
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Dry Food/Kibble
Wet/Canned Food
Raw Food
Dehydrated Food
Completely Homemade Diet
Some Human Food ( specifically made for them)
Some Human food (table food)
Treats
Other Resident Animal(s) Food
Kitty Box Treats
Wildlife/Bugs
Who knows?? (roams outdoors, neighbors, kids feed, etc)
What is the brand and type/flavor of food that your pet eats? What amounts of each type of food does your pet eat and how often? Please be as SPECIFIC as possible. We use this information when we calculate calories and create diet plans.
*
Other Facts, Quirks, and Preferences
Does your pet have any behavioral issues (barking, separation anxiety, destroying things, etc.)?
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Yes
No
If yes, please list or briefly describe
Is your pet generally food motivated?
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Yes
No
Are there any favorite foods/treats that we can use to help your pet have a good experience during their visit?
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Are there any places that your pet HATES to have touched (ears, feet, etc.)?
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Yes
No
Don't Know
If yes, which area(s)?
Has your pet ever bitten or scratched someone during a veterinary visit?
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Yes
No
If yes, do you know why (pain, fear, mishandling, etc.)?
*
Is there anything else that you would like us to know before your visit today?
*
New Clients
About Us
Our Team
Location & Hours
What To Expect
Take A Tour
Services
Wellness Exams
New Pet Care Consults
Spay & Neuter Services
Routine Vaccinations
Dental Care and Procedures
Emergency Visits
Surgical Services
Forms
Pet Health & Care Guides
How-To Videos
Pet Insurance
Pet Food Recalls
Pet Health Library
Product Recalls
News
Contact Us