New Patient & Owner Intake Form

Welcome to our veterinary clinic. Please tell us about your pet and yourself so our team can provide the best possible care. If you have any vaccination or medical records from a previous vet, feel free to upload them at the end.

Section 1 — Owner / Guardian Information

Owner full name:

Mobile phone (best number for reaching you during your pet’s visit):

Email address:

Home address:

Alternate contact (name & phone, in case we can’t reach you):

How did you hear about us?

Section 2 — About Your Pet

Pet’s name:

Species (please tick one):

Dog

Cat

Rabbit

Bird

Small mammal (hamster, guinea pig, ferret, etc.)

Reptile / exotic (please specify below)

Breed (or mix):

Date of birth (or best estimate of age):

Current weight:

Color / distinguishing markings:

Sex & reproductive status:

Male — intact

Male — neutered

Female — intact

Female — spayed

Microchip number (if microchipped):

Section 3 — Vaccination Status

Please tick every vaccine your pet has received. If you are unsure, leave unchecked — we will review records with you.

Rabies

DHPP / DA2PP (dogs — distemper, adenovirus, parvovirus, parainfluenza)

Leptospirosis (dogs)

Bordetella / kennel cough (dogs)

Canine influenza

FVRCP (cats — rhinotracheitis, calicivirus, panleukopenia)

FeLV (feline leukaemia)

My pet is unvaccinated or vaccination history is unknown

Date of most recent rabies booster (if known):

Section 4 — Parasite Prevention & Diet

Does your pet currently receive any of the following preventives?

Flea & tick preventive (monthly spot-on or chewable)

Heartworm preventive

Intestinal dewormer (within the last 6 months)

None of the above

Brand / product names of current preventives:

What does your pet eat each day (brand, wet/dry, amount, treats)?

Section 5 — Medical History & Current Concerns

Has your pet been diagnosed with any of the following? Tick all that apply:

Heart disease / heart murmur

Kidney or liver disease

Diabetes

Seizures / epilepsy

Arthritis / mobility issues

Skin allergies / recurring ear infections

Cancer / tumour history

Behaviour issues (aggression, anxiety, etc.)

None known

List all current medications & supplements (name, dose, how often):

Known drug, food, or environmental allergies:

Main reason for today’s visit (symptoms, wellness exam, vaccination, etc.):

Section 6 — Temperament & Handling

Knowing how your pet behaves at the vet helps us keep everyone safe and calm. Tick all that apply:

Usually friendly and relaxed

Shy or fearful in new places

Has bitten, scratched, or snapped at a handler before

Does not do well around other animals

Previously required a muzzle or sedation at a vet visit

Section 7 — Previous Vet & Records

Previous veterinary clinic name:

Previous clinic phone or email (for records transfer):

Upload vaccination records, prior bloodwork, or any documents you want us to review:

Thank you. Your pet is in good hands — our team will review this information before your visit and tailor the exam accordingly.