New Puppy/Kitten Exam History Form

Thank you for entrusting your pet’s care to us today! The following information will be used to help our veterinary team accurately complete your pet’s medical history for today’s visit.

female veterinary technician smiling while trimming golden retriever puppy's nails

New Puppy/Kitten Exam History Form
Has your contact information changed?
Who should we contact to make medical and financial decisions today?
Who should we contact to make medical and financial decisions today?
First Name
Last Name

The following vaccines are required for Day Admits.

DOGS: DHPP—RV—Bordetella | CATS: FVRCP—RV

Our veterinary team will use the following information during today's visit. Please answer the questions to the best of your ability.

Where was puppy/kitten obtained?
Where will the puppy/kitten stay?
When outdoors is your pet?
Do you have your pet primarily for?
Wet or dry?
What do the feces look like?
Any signs of illness (check all that apply)?
Any other animals in the home?
Any itching, scooting or licking or biting of paws?
Would you like us to trim the nails today?
Would you allow Van Crest to use photos of your pet for advertising, promotions, or social media?