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Veterinary Intake · Popular

Streamline New Pet Owner Registration at Your Clinic

Collect pet owner details, animal information, and full medical history with this easy-to-use veterinary intake form template.

Use This Template Free Preview

Aura theme

formbuilder.ai/f/veterinary-clinic-new-pet-owner-registration-animal-medical-history-intake-form

Veterinary Clinic New Pet Owner Registration & Animal Medical History Intake Form

Owner's Full Name

· · ·

Email Address

· · ·

Phone Number

· · ·

Submit

The Veterinary Clinic New Pet Owner Registration & Animal Medical History Intake Form is designed to help veterinary practices efficiently onboard new clients and their pets. It captures essential owner contact details, preferred communication methods, and even how they discovered your clinic — making it easy to manage patient records from day one.

This form also collects comprehensive pet profile information, including species, breed, sex, reproductive status, date of birth, weight, color/markings, and even a photo upload. A dedicated medical history section gathers prior veterinary care details, ensuring your clinical team has everything they need before the first appointment begins.

Whether you run a small animal clinic, a multi-specialty practice, or a mobile veterinary service, this template saves time for both staff and pet owners. Replace paper forms with a digital solution that keeps your intake process organized, professional, and completely customizable to fit your clinic's needs.

4 Pages

30 Questions

~10min To complete

Free No credit card needed

Field types Short Text ×5 Yes / No ×4 Single Choice ×3 Long Text ×3 Phone ×2 Dropdown ×2 File Upload ×2 Multiple Choice ×2 Full Name Email Address Date number 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 Email Address * Email

3 Phone Number * Phone

4 Home Address * Address

5 Preferred Contact Method * Single Choice

6 How did you hear about our clinic? Single Choice

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) * Date

7 Weight (lbs) number

8 Color/Markings Short Text

9 Upload a Photo of Your Pet File Upload

Page 3 Medical History 8 questions

Animal Medical History

1 Has your pet been seen by another veterinarian before? * Yes / No

2 Previous Veterinary Clinic Name Short Text

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

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

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

6 Please describe any past surgeries, hospitalizations, or major illnesses Long Text

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

8 Upload Previous Vaccination Records (if available) File Upload

Page 4 Additional Information & Consent 7 questions

Behavioral & Lifestyle Information

1 Pet's Diet Type * Dropdown

2 Does your pet exhibit any of the following behaviors? Multiple Choice

3 Any additional concerns or information you'd like us to know about your pet? Long Text

Emergency Contact & Consent

4 Emergency Contact Name * Short Text

5 Emergency Contact Phone Number * Phone

6 I authorize the veterinary team to provide emergency treatment if my pet requires immediate care and I cannot be reached. I confirm that the information provided above is accurate to the best of my knowledge. * termsandconditions

7 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.