Veterinary Clinic
Patient intake, surgery and euthanasia consents, treatment estimates, discharge instructions, and boarding agreements for small-animal veterinary practices
Get started with PocperPatient intake, surgery and euthanasia consents, treatment estimates, discharge instructions, and boarding agreements for small-animal veterinary practices
Get started with PocperWelcome 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.
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?
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):
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):
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)?
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.):
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
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.
The New Patient & Owner Intake Form template is a ready-to-use form from Pocper's Veterinary Clinic pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.