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Veterinary Intake  ·  Popular

Streamline New Patient Intake at Your Vet Clinic

Easily gather owner contact info, pet details, and medical history with this free veterinary clinic intake form template.

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Terra theme
formbuilder.ai/f/new-pet-owner-veterinary-clinic-intake-form
New Pet & Owner Veterinary Clinic Intake Form
Owner's Full Name
· · ·
Phone Number
· · ·
Email Address
· · ·
Submit

The New Pet & Owner Veterinary Clinic Intake Form is designed to help veterinary practices efficiently collect all essential information when welcoming new patients. From owner contact details and emergency contacts to pet species, breed, age, and weight, this template ensures your staff has everything they need before the first appointment begins.

This form is ideal for general veterinary clinics, specialty animal hospitals, and mobile vet services. It captures critical medical and vaccination history, including prior vet visits and clinic names, helping your team provide informed, continuity-of-care from day one. Fields for microchip status, spay/neuter information, and color markings make pet identification quick and accurate.

By digitizing your intake process, you reduce paperwork, minimize errors, and improve the client experience. Responses are collected securely and can be reviewed before the appointment, saving valuable consultation time. Customize the form to match your clinic's branding and specific needs with ease.

4 Pages
26 Questions
~9min To complete
Free No credit card needed
Field types Short Text ×5 Yes / No ×3 Long Text ×3 Single Choice ×2 Dropdown ×2 Full Name Phone Email Address Date number singlecheckbox File Upload Multiple Choice termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Owner Information 6 questions
Owner Information
1 Owner's Full Name * Full Name
2 Phone Number * Phone
3 Email Address * Email
4 Home Address * Address
5 Preferred Contact Method * Single Choice
6 Emergency Contact Name & Phone Short Text
Page 2 Pet Information 9 questions
Pet Details
1 Pet's Name * Short Text
2 Species * Dropdown
3 Breed * Short Text
4 Sex * Single Choice
5 Is your pet spayed or neutered? * Yes / No
6 Date of Birth (or approximate age) Date
7 Weight (lbs) number
8 Color / Markings Short Text
9 Microchipped singlecheckbox
Page 3 Medical History 7 questions
Medical & Vaccination History
1 Has your pet been seen by another veterinarian before? * Yes / No
2 Previous Veterinary Clinic Name Short Text
3 Are your pet's vaccinations up to date? * Yes / No
4 Upload Vaccination Records or Previous Medical Records File Upload
5 Does your pet have any known medical conditions? * Multiple Choice
6 Current Medications & Dosages Long Text
7 Please describe any past surgeries, injuries, or hospitalizations Long Text
Page 4 Visit Details & Consent 4 questions
Reason for Today's Visit
1 Visit Type * Dropdown
2 Please describe your pet's symptoms or concerns in detail * Long Text
Authorization & Consent
By signing below, I authorize the veterinary staff to examine and treat my pet. I understand that I am financially responsible for all services rendered and that a treatment estimate will be provided before any major procedures.
3 I have read and agree to the clinic's policies, including the payment and cancellation policy * termsandconditions
4 Owner's Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Terra" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Free to use on any plan, no credit card required

Use this template

Free to use. Open in the editor, customize, and publish in minutes.

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Category Intake & Onboarding
Subcategory Veterinary Intake
Theme Terra
Badge Popular
Price Free
Coding required None
Tags
Veterinary Onboarding Pet Care

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