Canine Health History Form

Thank you for giving us the opportunity to care for your pet. To help us provide optimal healthcare, please take time to fill out this information.

Name(Required)
Is your pet's birth date/ age exact or estimated?(Required)
Sex(Required)
Please select how you would best describe your pet's temperament for examination:(Required)
Please fill out the following information to the best of your ability. We can confirm much of this information from previous records if they are available. If you have any questions about this information, our veterinary technicians will assist you as they review your pet’s medical history.
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Did they also check for Lyme?
Heartworm Preventative:
Heartworm Prevention Used:
Products Used:
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Rabies Vaccine Length:
Do you have plans to board or travel in the next 6-12 months?
Do you trim your dog's nails?
Do you brush your dog's teeth?
MM slash DD slash YYYY
Other pet's in household (if applicable)