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
Mobile phone (best number for reaching you during your pet’s visit):
Section 2 — About Your Pet
Species (please tick one):
Date of birth (or best estimate of age):
Section 3 — Vaccination Status
Please tick every vaccine your pet has received. If you are unsure, leave unchecked — we will review records with you.
Date of most recent rabies booster (if known):
Section 4 — Medical History & Current Concerns
Has your pet been diagnosed with any of the following? Tick all that apply:
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 5 — Temperament & Handling
Knowing how your pet behaves at the vet helps us keep everyone safe and calm. Tick all that apply:
Section 6 — Previous Vet & Records
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.