Important information regarding your dog or cat’s history.

When filling out the form below, please keep in mind that a response usually takes 24-48 hours. If you are seeking a more immediate response, please call us during our regular business hours at 281-495-9445.

Date *

Name *

First

Last

Email *

Phone *

Referring Veterinary Hospital

Pet's Name *

Species *

Cat
Dog

Breed

Background Information

Length of time with family? *

Vaccination History

Please have a copy of your pet's vaccination history available at the time of appointment or have your past veterinarian fax a copy to our office.

Grooming Schedule *

Professional
Personal
None

Will your pet be used for breeding? *

Yes
No

Is your pet spayed or neutered? *

Yes
No

Is your pet on heartworm prevention? *

Yes, I give my pet prevention monthly
Yes, but only during the summer months
Yes, but have missed doses
No

Is your pet on flea / tick prevention? *

Yes, I give my pet prevention monthly
Yes, but only during the summer months
Yes, but have missed doses
No

Please list any medication that your pet is on and how frequently it is given.

How many hours does your pet spend outside? *

What kind of dental prevention are you using? How often are you using this prevention? *

What types of toys are available to your pet?

Rawhide
Plastic
Stuffed
Bones

Do you have any other pets? *

Yes
No

How much are you currently feeding? How often do you feed your pet? *

Do you feed your pet people food? *

Yes
No

Past medical history or problems.

Current presenting problem.

Does your pet require any special handling?

Please type your name to electronically sign your form indicating that all information is correct for your pet. *

Digital Signature

Phone

Cat and Dog History Form

Important information regarding your dog or cat’s history.