Medical History Form

Make the most of your next appointment by saving time! Before your appointment, fill out your medical history form from any device at any time.

Get Started

Medical History Form

Name *

First

Last

Email *

Phone

Pet's Name *

Please tell us about the primary reason for your visit today: *

List any medications your pet is currently taking:

(if none, type none. Please include supplements, flea prevention, and heartworm prevention)

List any known allergies:

Describe your pet's activity level:

How would you describe your pet’s weight?

What proportion of time does your pet spend indoors or outdoors?

What does your pet eat? (Brand, type, amount, treats, human food, etc.)

Have there been any changes to your pet's diet in the last 4 weeks?

Signature *

Clear Signature

I authorize Rancho San Carlos Pet Clinic to perform a complete physical examination for my pet. I understand that the attending veterinarian will make every effort to contact me at the above number regarding treatment of my pet. I understand that payment in full for medical services provided is due at the time of discharge of my pet and that I may be asked to leave a deposit prior to the start of services. Rancho San Carlos Pet Clinic will take every reasonable action to ensure the success of medical services, however there is no guarantee, nor can one be made, as to the results or cure of any therapy.

Medical History Form

Medical History Form

Ready to Visit Us?

Visit the Rancho San Carlos Pet Clinic

Have a Question?

Address

Contact

Hours

Emergency Resources