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Veterinary Intake · Popular

Streamline New Pet Patient Intake at Your Clinic

Gather pet owner info, pet details, and health history with this ready-to-use veterinary new patient intake form template.

Use This Template Free Preview

Jade theme

formbuilder.ai/f/veterinary-hospital-new-patient-pet-health-history-intake-form

Veterinary Hospital New Patient & Pet Health History Intake Form

Owner's Full Name

· · ·

Primary Phone Number

· · ·

Email Address

· · ·

Submit

The Veterinary Hospital New Patient & Pet Health History Intake Form is designed to help veterinary clinics and animal hospitals efficiently onboard new patients. It collects essential information including pet owner contact details, emergency contacts, and how they discovered your practice — all in one organized digital form.

Veterinary staff can capture comprehensive pet details such as species, breed, date of birth, sex, spay/neuter status, color and markings, weight, and microchip number. The form also gathers critical medical history, including the pet's previous veterinarian and any current medications, giving your team the context they need before the first appointment.

By digitizing this intake process, veterinary practices reduce paperwork, minimize errors, and create a smoother, more professional experience for pet owners. Customize the form to match your clinic's branding and workflow, and start collecting accurate patient records from day one.

4 Pages

27 Questions

~9min To complete

Free No credit card needed

Field types Short Text ×6 Yes / No ×3 Long Text ×3 Phone ×2 Single Choice ×2 Date ×2 Full Name Email Address number Multiple Choice File Upload Dropdown 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

Pet Owner Details

1 Owner's Full Name * Full Name

2 Primary Phone Number * Phone

3 Email Address * Email

4 Home Address * Address

5 Emergency Contact Phone Number Phone

6 How did you hear about our hospital? Short Text

Page 2 Pet Information 9 questions

Pet Details

1 Pet's Name * Short Text

2 Species * Single Choice

3 Breed * Short Text

4 Date of Birth (or approximate age) * Date

5 Sex * Single Choice

6 Is your pet spayed or neutered? * Yes / No

7 Color / Markings Short Text

8 Weight (lbs) number

9 Microchip Number (if known) Short Text

Page 3 Medical & Vaccination History 9 questions

Health & Medical History

1 Previous Veterinarian / Clinic Name Short Text

2 Is your pet currently on any medications? * Yes / No

3 If yes, please list all current medications and dosages Long Text

4 Has your pet ever been diagnosed with any of the following? * Multiple Choice

5 Please describe any past surgeries, hospitalizations, or significant injuries Long Text

6 Are your pet's vaccinations up to date? * Yes / No

7 Upload vaccination records or previous medical documents File Upload

8 What is the primary reason for today's visit? * Dropdown

9 Please describe any current symptoms or concerns in detail Long Text

Page 4 Consent & Authorization 3 questions

Consent & Acknowledgment

By signing below, you confirm that the information provided is accurate to the best of your knowledge. You authorize our veterinary team to examine and provide necessary treatment for your pet. You understand that a treatment estimate will be provided and your approval obtained before any procedures beyond the initial examination are performed.

1 I have read and agree to the hospital's policies, including payment terms and consent to treat * termsandconditions

2 Owner's Signature * Signature

3 Date * Date

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.