Pet Information Form
New Baltimore Animal Hospital
Client's Name:
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Pet's Name:
*
Species:
*
Cat
Dog
Other
Gender:
*
Male
Neutered Male
Female
Spayed Female
Breed:
*
Color:
*
Date of Birth or estimated if uncertain:
*
-
Month
-
Day
Year
Date
Is your pet microchipped?
*
Yes
No
Uncertain
If yes, chip number here:
If your pet has been seen at another veterinary office we can receive records from, please list:
*
Vaccine Status:
*
Up to date, please email a copy to: info@newbaltimoreanimalhospital.com
Need some vaccines
Unvaccinated
Uncertain
Are you a first-time pet owner?
*
Yes
No
Where did you get your pet?
*
Shelter/Rescue organization
Breeder
Stray
Previous feral neighborhood cat/dog
My pet is currently on the following medications, (including vitamins and supplements:
*
My pet's current diet, including treats is:
*
Does your pet have any medical conditions, or medical history we should be aware of?
*
List any major surgeries or illnesses:
*
Best description of your pet during a nail trim:
*
Precious love bug
Has his/her moments
Little troublesome
Definitely need to muzzle
Uncertain
Has your pet required a muzzle for certain procedures?
*
Yes
No
N/A
Does your pet suffer from separation or thunderstorm anxiety?
*
Yes
No
Uncertain, but I'm willing to discuss this with my doctor at the appointment.
Has your dog ever had any formal obedience training?
*
Yes
No
N/A
Does your dog have any problems or issues in the following areas:
*
Mouthing
Barking
Jumping
Chewing
Housetraining/marking
Aggression
Raiding Garbage can
Submit
Should be Empty: