New Patient Form
The Kind Paw Co. LLC New Patient Form required for each pet
Patient Name
*
Patient First Name
Patient Last Name
*
Dog
Cat
*
Female/Spayed
Male/Neuterd
Female/Intact
Male/Intact
Approximate weight in pounds:
Date of birth or Age in years
*
Has your pet ever required any modifications for care at their primary veterinarian:
Muzzle
Oral medications for sedation
Injectable sedation
Other
Has your pet ever bitten anyone inside or outside of your home? (this does not mean service will be denied, this information is for safety modifications only)
*
Please Select
No, my pet does not have a bite history
Yes, my pet has bitten someone in the past
Please upload proof of rabies vaccination for your pet. A picture of rabies vaccine reminder is sufficient.
*
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Primary Veterinarian:
Does your pet have any medical history or diagnosed medical problems:
*
Anything else you would like us to know about your pet:
Any allergies in the home or food items that you do not want offered? (such as: peanut butter, chicken flavor, cheese etc )
*
The Kind Paw Co. LLC may require your help to restrain or distract your pet to receive care
*
Please Select
I am comfortable and able to restrain my pet
I am not comfortable or not able to restrain my pet
My signing here you understand that The Kind Paw Co. LLC is not responsible for any injuries to the caregiver, animal being treated, and other household pets. You do not hold The Kind Paw Co. LLC responsible for any injuries arising from or relating to treatments rendered, including damage to private property.
Date
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Month
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Day
Year
Date
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