Sandhills Animal Hospital Pet Health History
Pet Health History
Date
-
Month
-
Day
Year
Date
Owner's Name
First Name
Last Name
Name of Pet
Type of Animal
Dog
Cat
Ferret
Rabbit
Other
If other selected above, describe
Breed
Color/Description
Birthdate (Age)
Sex
Male
Female
Unknown
Does your pet have any chronic health problems we should know about? (kidney problems, heart conditions, arthritis, diabetes, etc.) Please describe
Vaccine History
DHPP
Corona
Leptospirosis
Bordetella
Influenza
Lyme
Rabies
FVRCP (distemper)
Feline Leukemia
Has your pet been checked for intestinal worms within the past 6 months (fecal exam)? If yes, please list results):
Is your pet (dog, cat, ferret) on heartworm preventative? (monthly tables or 6 or 12 month injection)
Has your dog/cat been checked for heartworms within the past year? If yes, when and list results?
Has your pet ever had an allergic reaction to any medication or vaccination? If yes, please describe:
Is there any special health care question we can help you with today?
Please provide the names and phone numbers of other animal hospitals that have records for your pet to help us provide the best possible care.
Thank you for your help in completing our records.
Submit
Should be Empty: