• Pet Medical History Form

  • Thank you for taking the time to answer these questions! We want to get the most updated information for your pet so we can address all your health concerns and questions.

  • Appointment Date
     - -
    2 digit month, 2 digit day, 4 digit year
  •  :

  • This form should take 3-5 minutes to fill out. Page 1/5

  • Clinic Policies

  • Please see our website for the most current policy updates:

    • Respiratory Infection Policy
    • Late Arrival, Cancellation, and Missed Appointments
    • Low Stress Handling
    • Informed Consent
    • Payment Policies (We accept Cash, Check with ID, Credit Cards, CareCredit and Sunbit)

    Let us know before your appointment if you have any questions or concerns about these policies.

  • Please indicate that you have read and agree to the clinic policies, including the policy on low stress handling and pre-visit calming medications. If you decline to give pre-visit calming medications that have been prescribed for your pet, and your pet is showing signs of Fear, Anxiety, or Stress, sedation or rescheduling may be required.*

  • Do you or any members of your household have symptoms of respiratory disease, exposure to COVID-19, or a positive COVID-19 test result within the past 30 days?*

  • Page 2/5

  • What is your primary reason for this appointment?*

  • Since you noticed it, is the problem getting:*

  • Page 3/5

  • Has your pet recently experienced any other changes? (Select all that apply)*

  • Do you have any other pets in the house?*

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  • Page 4/5

  • Has your pet received vaccines?*
  • Does your pet receive prevention for heartworms and intestinal parasites?*
  • Does your pet receive prevention for fleas & ticks?*

  • Page 5/5

  • Should be Empty: