Canine Intake Form

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Canine Intake Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

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Pet Name: *

Date of Birth: *

Outdoor Only?

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Gender: *

Neutered/Spayed? *

Microchiped *

Chip # *

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Breed or Breed Mix: *

How did you acquire your pet? *

Color: *

When *

Previous Veterinary Clinic:

Do we have permission to request medical records? *

Please initial: *

Are vaccinations up to date? *

When given? *

List any chronic or recurring medical problems (e.g. arthritis, vomiting, diarrhea, cough, urinary tract problems, positive fecal testing, etc.) *

Please list any current medications, vitamins and/or supplements being given to your pet: *

Date of last flea control medication *

Brand *

What is your pet's regular diet (e.g. dry food, canned food, brand of food): *

How much food do you give and how often: *

Describe briefly lifestyle (e.g., active, dog parks, mostly indoors, goes to groomer, daycare, hunts...): *

Does your dog travel outside of Western WA? *

If so, where? *

Email *

Owner name *

Date *

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We proudly serve pets of Mukilteo, Everett, Seattle, Lynwood, Edmonds, Marysville, Lake Stevens, Mill Creek, Arlington, Bothell, and surrounding areas. We are excited to meet you and your furry friend! Kindly schedule an appointment by clicking on the button provided below.

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