New Puppy/ Kitten Exam History Form Complete your forms online before your visit. Get Started New Puppy/Kitten Exam History Form Please enable JavaScript in your browser to complete this form.Primary Number for Text Reminders *Primary Email for Notifications *Has your contact information changed? *YesNoWho should we contact to make medical and financial decisions today? *FirstLastWhat is the best contact phone number for today? *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? *BreederShelterPet StoreOtherIf other, please specify *How long have you owned the puppy/kitten? *Where will the puppy/kitten stay? *Indoors OnlyIndoors/OutdoorsOutdoors OnlyBarnOtherIf other, please specify *When outdoors is your pet? *LooseLeashedFencedOtherIf other, please specify *Do you have your pet primarily for? *CompanionShowBreedingWhat brand of food fed? *Wet or dry? *Wet FoodDry FoodFrequency *Amount *Previous vaccines administered *Previous worm meds given *Previous meds administered *What do the feces look like? *Normal Formed StoolsMushy DiarrheaWatery DiarrheaAny signs of illness (check all that apply)? *AppetiteCoughingSneezingVomitingNone of the aboveAny other animals in the home? *YesNoPlease list the species and how many *Any itching, scooting or licking or biting of paws? *YesNoWould you like us to trim the nails today? *YesNoAny other concerns or questions?Would you allow Van Crest to use photos of your pet for advertising, promotions, or social media? *YesNoSignature * Clear Signature Submit
