Owner's Name *

First

Last

Email *

Pet's Name *

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 seeing the veterinarian? *

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

Yes
No

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? *

Yes
No

History & Environment

How long has your pet lived with you? *

Where did you get your pet?

Did you get to see mom or dad? *

Yes
No

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

Does your pet go outdoors? *

Yes
No

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

Yes
No

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

Yes
No

If yes, please describe *

Has your pet been spayed or neutered? *

Spayed
Neutered
No

Has your pet had his/her teeth cleaned professionally? *

Yes
No

If yes, how recent? *

Do you do any at-home dental care? *

Yes
No

If yes, what and how often? *

Diet

What type of food does your pet currently eat? *

Dry
Canned
Other

If other, please specify *

Brand, Amount and Frequency *

Does your pet receive any vitamins or supplements? *

Yes
No

If yes, please list the brand, type, amount, and frequency *

Does your pet eat people's food? *

Yes
No

Does your pet eat treats? *

Yes
No

Does your pet have food sensitivities or allergies to anything? *

Yes
No

If yes, please explain *

Medications

Do you give heartworm/parasite preventative to your pet? *

Yes
No

Name of Medication & Date of Last Dosage *

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

Yes
No

Name of Treatment & Date of Last Dosage *

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

Yes
No

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

Yes
No

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

Click or drag files to this area to upload. You can upload up to 5 files.

All Paws Veterinary Clinic

Initial History Form