New Pet History Form – Dogs, Cat

    Your Pet's Name:

    Your First Name:

    Your Last Name:



    How should we contact you?

    Type of Pet:

    Where did you get your pet?

    How long have you owned your pet?

    What prior illness or health issues has your pet had?

    How often do you bathe your pet?

    How often do you brush/comb your pet?

    What type of exercise does your pet receive, and how often?

    How often is your pet around other animals (other than your own)?

    How much time does your pet spend outside?

    Which wildlife is in your area? (Choose all that apply) *


    Does your pet go to: (Choose all that apply) *

    GroomerBoardingPet ShowsPet StoresNone of the Above

    Do you travel with your pet? If so, where else has your pet been?

    Is your pet on pet insurance


    Is Your pet Spayed or Neutered? *


    If you chose NO for the previous questions, do you plan to have it done?


    Do you plan to breed your pet? *


    Does your pet have any drug or vaccine reactions? *


    Does your pet hunt?*


    Is your pet on a preventative for controlling external parasites? (fleas and ticks) *


    Is your pet on a preventative for controlling internal parasites? (heartworm, roundworm, etc) *


    Has your pet been micro-chipped or tattooed? *


    Has your pet ever had professional dental care? *


    Do you understand the health benefits and life extending effects of providing proper dental care for *


    Do you trim your pet's nails at home? *


    Would you like to learn how to trim your pet's nails? *


    Check any of the following that are of concern to you regarding your pet's behavior/health *
    (Check all that apply)

    Excessive BarkingHouse TrainingSoiling/Spraying insideProblems around childrenSheddingAnxietyJumpingStraying from homeItching/scratchingOverly rambunctiousBitingClawing or diggingBad breathDestructive BehaviorNone of the Above

    Which of the following are services that you might utilize: *
    (Check all that apply)

    Lodging/boarding facilityReferral rewards programWellness plansMassage therapyEvening hoursGroomingDay careProduct trials

    In an emergency where you can not be immediately contacted, you want Companions Animal Hospital to: *

    Provide CPRDo not resuscitate