Submit the completed form in person at the veterinary office for initial processing. For email submissions, send the form as an attachment to the clinic's designated email. If faxing, use the provided fax number on the form to ensure a secure submission. Always review the instructions provided by your veterinary clinic regarding preferred submission methods.

Important dates for this form may vary by veterinary practice. Always check with your veterinarian for their specific requirements related to vaccinations and regular check-ups.

This form's primary purpose is to gather essential medical and contact information about your pet. It allows pet owners to communicate effectively any concerns and special needs related to the pet's visit. Completing this document ensures that veterinary staff are well-informed and prepared to provide the best care during appointments.

• 1. Today's Date: The current date of the visit.
• 2. Your Name: The name of the pet owner.
• 3. Pet Name: The name of the pet being dropped off.
• 4. Emergency Contact Name: Name of the person we should contact in an emergency.
• 5. First Phone Number: Primary contact number.
• 6. Second Phone Number: Alternate contact number.
• 7. Reason for Visit: Checkbox options for different types of visits.
• 8. Concerns: Checkbox options to indicate any specific health concerns.
• 9. Additional Comments: Open field for extra notes regarding the visit.
• 10. Last Time Ate: Indication of when the pet was last fed.
• 11. Medication Information: Checkbox and fields to indicate current medications.
• 12. Pick Up Time: Expected time for the pet to be picked up after treatment.
• 13. Additional Services Needed: Checkbox options for extra services requested.
• 14. Signatures: Initials needed to confirm understanding of policies.

Failure to submit the form may lead to incomplete medical records for your pet. This could result in delays during the appointment or missed essential information that could impact care. Always ensure the form is filled out accurately and submitted beforehand.

• Incomplete Medical History: The vet may lack crucial information needed to treat your pet effectively.
• Delayed Appointment: Missing information could result in longer wait times during your visit.
• Potential Miscommunication: Important concerns might not be addressed if not indicated on the form.

• 1. Routine Check-ups: Use this form each time you bring your pet for a regular health evaluation.
• 2. Emergency Visits: Fill it out for urgent situations to relay immediate health concerns.
• 3. Surgical Procedures: Necessary for pets undergoing anesthesia or other surgical interventions.
• 4. Behavioral Consultations: Important for discussing behavioral issues and health impacts.
• 5. New Pet Visits: Vital for first-time visits to establish a care baseline and history.