New Pet Welcome Form

New Pet Welcome Form

101 Post Office Drive, Indian Trail NC (704)821-7040 Fax: (704)821-4692
Pet's Name:
Last Name:
Would you like to share how your pet got his/her name?
DOB or approximate age
What type of animal is your pet?

Other
What breed is your pet?
Please check all that apply for your pet:
What color is your pet?
Does your pet have any unusual markings?
Does your pet have a microchip?
If yes, what is the Microchip #?
What is the name and phone number of previous Veterinarian(s) where past records may be obtained?
If your pet has been treated for an illness in the past year, please explain:
List any previous surgeries
If your pet has ever had a reaction to a vaccine or medication, please explain:
List any medications your pet is currently taking (including heartworm, flea & tick prevention)
Is your pet:
Does your pet get anxious:
Do specific procedures cause anxiety? Check all that apply:

Other
What is the pet's primary role in the family? (family pet, therapy/emotional support, barn cat, etc.)
Do children live in the home?
Does your pet: (check all that apply)
Do you have pet insurance?
Which company?
Anything else we should know about your pet or your approach to your pet's healthcare?
I ASSUME RESPONSIBILITY FOR ALL CHARGES INCURRED IN THE CARE OF THIS ANIMAL. I ALSO UNDERSTAND THAT THESE CHARGES WILL BE PAID AT THE TIME OF RELEASE AND THAT A DEPOSIT MAY BE REQUIRED FOR SURGICAL TREATMENT. I ALSO GRANT INDIAN TRAIL ANIMAL HOSPITAL PERMISSION TO POST MY PET'S PICTURE, STORY, AND MEDICAL INFORMATION ON SOCIAL MEDIA.
Owner or Responsible Party Signature
Date

MonthDayYear
Date
Printed Name
Should be Empty: