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Home
Our Hospital
Our Doctors
Hospital Tour
Careers
Emergency Information
Covid-19 Information
Anesthesia and Your Pet
Ticks! Now What?
Patient History Form
Canine and Feline History Form
Exotic Mammal History Form
Owner Information Form
Services
Wellness Exams
Spay & Neuter
Vaccinations
Microchipping
Dental Care
Large Animal Services
View All Services
Equine Services
Payment Options
Shop Online
Contact Us
517-223-8812
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Canine and Feline History Form
Canine and Feline History Form
Client Information
Owner Name
(Required)
Owner Phone
(Required)
Patient Information
Pet's Name
(Required)
Species
(Required)
Age
(Required)
Color
(Required)
Gender
(Required)
Male
Female
Unknown
Spayed or neutered status
(Required)
Neutered
Spayed
Intact
Reason for Visit
(Required)
Current Diet (amount, frequency), including treats
(Required)
Any Changes in Drinking
(Required)
Please select all the locations your pet goes to
(Required)
Groomer
Boarding
Kennel
Daycare
Classes
None
Where does your pet go to be groomed
(Required)
Where does your pet go to be boarded
(Required)
Where does your pet go to be kenneled
(Required)
Where does your pet go for daycare
(Required)
Where does your pet go for classes
(Required)
Is your pet on Heartworm Prevention?
(Required)
Yes
No
When was the last dose of Heartworm Prevention given and what brand
(Required)
Do you give Heartworm Prevention year-round or seasonally
(Required)
Year-Round
Seasonally
Is your pet on Flea and Tick Prevention
(Required)
Yes
No
When was the last dose of Flea and Tick Prevention given and what brand
(Required)
Do you give Flea and Tick Prevention year-round or seasonally
(Required)
Year-Round
Seasonally
Is your pet on any Current Medications or Supplements
(Required)
Yes
No
Please list the Current Medications or Supplements your pet is on
(Required)
Has your pet received any previous vaccines
(Required)
Yes
No
Please list any previous vaccines your pet has received
(Required)
Has your pet had any previous vaccine reactions
(Required)
Yes
No
Please explain any previous vaccine reactions your pet has had
(Required)
Are there any other issues or concerns you'd like to discuss with the doctor?
(Required)
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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