New Pet FormOwner's InformationName* First Last Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*TypeCellHomeWorkFaxPET INFORMATIONPet's Name*Species* Cat Dog Breed*Color*Date of Birth (Approximate)*Sex* Intact Male Neutered Male Intact Female Spayed Female Unknown PET QUESTIONNAIREWhich of the following best describes your pet?* Family Member Child's Pet Backyard Pet Where does your pet spend their time?* Indoor only Outdoor only Both Has you pet had any serious illnesses or surgeries?*Does your pet have any allergies to vaccinations or medications?*Is your pet on any special diets or medications?*Would you like to be present during the treatment of your pet?* Yes No Have you had your pet genetically tested?* Yes, breed only Yes, breed and health results No If you have genetic results, please upload them here Drop files here or Select filesMax. file size: 64 MB.Do you use a Groomer or Boarding Kennel?* Yes No Do you travel, hike, camp or hunt with your pet?* Yes No Are you currently using any type of flea preventive?* Yes No Does your pet have a microchip?* Yes No It would be helpful to the treatment of your pet if we could obtain his/her previous medical records. May we contact your previous Veterinarian to obtain them?* Yes No Who was your previous Veterinarian?*If you have a copy of your pet's previous records, please upload them here Drop files here or Select filesMax. file size: 64 MB.The health status of your human family may effect the medical recommendations for your pet's preventative healthcare. Is anyone in your household immune compromised (Cancer, Diabetes, Hepatitis or HIV positive)?* Yes No Do you consent to photos of your pet being utilized in hospital promotions and on Social Media?* Yes No CAPTCHA