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Client In-take Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.
  • Owner's Name

  • Pet Information

  • (vomiting/diarrhea/abnormal urination/sneezing/eye or nasal discharge/lethargy/not eating or drinking/sores/scratching/licking/chewing/lumps/weight/behavior change/limping/etc.)
  • (heart murmur/allergies/etc.)
  • If yes, what medication(s)/dose/how much/last given?
  • If yes, where were they given, what vaccines & the next due date?
  • Reptiles (enclosure/substrate/temperatures/humidity/lighting (UVB)/etc.) Small mammals/rabbits (enclosure/bedding/toys/indoor or outdoor) Bird (enclosure/substrate/toys)