Initial History Form

Whether you are new to our hospital or have been here previously with another pet, we want you to know you are a very important part of your pet's health care team. This information you provide about your pet is vital to our doctor's ability to identify or prevent health problems. Please do not hesitate to ask any questions concerning any aspect of your pet's care.

Now let us learn more about your pet! We want your pet to enjoy this visit! Please help us by telling our team what your pet likes and dislikes.

How does your pet feel about being at the veterinarians?

Is it okay for us to give your pet food rewards (treats)?

*Please let us know if there are any household allergies, i.e. peanut butter.

Has your pet ever had an adverse medical reaction to any type of vaccination, medication, or anesthetic?

History and Environment

How long has your pet lived with you?

Where did you get your pet?

Did you get to see mom or dad?

Does your pet frequent daycare, boarding facilities, dog parks or loves to travel with you?

Does your pet go outdoors?

Does your pet ever drink from streams, lakes, creeks, or rivers?

Has your pet ever been treated for any previous illnesses, accidents, or surgeries?

Has your pet been spayed or neutered?

Has your pet had his/her teeth cleaned professionally?

Do you do any at-home dental care?

Diet

What type of food does your pet currently eat?

Brand, Amount and Frequency

Does your pet receive any vitamins or supplements?

Does your pet eat people's food?

Treats?

Does your pet have food sensitivities or allergies to anything?

Medications

Do you give heartworm/parasite preventative to your pet?

Name of Medication
Date of Last Dosage

Do you apply topical or administer oral flea/tick treatments to your pet?

Name of Treatment
Date of Last Dosage

Has your pet ever been prescribed medication to help with a visit to the veterinarian?

Has your pet ever been prescribed medication to help with a visit to the veterinarian?

We love social media! Do you have permission to share your pet's image and story on your social media, website, Facebook and other forms of related media? Your personal information will never be shared.

Please attached any records you may have and a cute picture of your pet for their chart!