New Pet Form

Owner's Information

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Type

PET INFORMATION

Pet's Name*

Species*

Cat
Dog

Breed*

Color*

Date of Birth (Approximate)*

Sex*

PET QUESTIONNAIRE

Which 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

Max. 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

Max. 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

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Telford Veterinary Hospital

Owner's Information

PET INFORMATION

PET QUESTIONNAIRE

Our Location

Appointments