Puppy’s First Visit History Form

Thank you for choosing Healing Paws Veterinary Care. The information you provide in this form allows us to personalize your puppy’s care and to help us set your puppy up to live its best life! We truly appreciate your time to give us these answers as they allow us to work together with you to give your puppy the best.

Please submit this form prior to your appointment time and please bring a fresh sample of your puppy’s stool to the visit! If you have any questions, please give us a call. We look forward to seeing you and your pet!

Puppy's Name(Required)

We'll have a small bag of high-quality puppy food, a special surprise, and lots of love waiting for your puppy at their visit - we can not wait to meet your new best friend!

Owner's Name Bringing Puppy To The Visit (must be 18 or older)(Required)

First Last

Mobile Phone Number of Owner Coming To The Visit(Required)

Email(Required)

When did you bring your puppy home?(Required)

MM slash DD slash YYYY

Has your puppy had any vaccinations?(Required)

Yes

I don't know

Please tell us the date your puppy last received vaccinations. Also, please bring record of these vaccinations along to your visit.(Required)

What brand of food is your puppy currently eating?(Required)

Is this the brand of food the puppy was eating at the breeder, pet shop, or rescue?(Required)

Yes

I'm not sure

Is your puppy eating all of its food at each meal?(Required)

Yes

Please tell us more about that(Required)

Is this your first puppy?(Required)

Yes

Approximately how many times a day does your puppy have a bowel movement?(Required)

Is your puppy's stool always formed and shaped like a Tootsie Roll?(Required)

Yes

No - it varies in shape and firmness

No - it is always soft or liquid

No - it is very hard

Other

If other, please describe(Required)

Has your puppy vomited since you adopted it?(Required)

Yes

Please tell us how often they are vomiting and what the vomit looks like(Required)

Has the breeder, pet shop, or rescue sent home any heartworm, flea, tick or parasite preventions to give to your puppy?(Required)

Yes

I'm not sure

Please tell us what they sent and when you are supposed to give it(Required)

Has the breeder, pet shop, or rescue sent home any medications, supplements or vitamins for your puppy?(Required)

Yes

I'm not sure

Please tell us what they sent and when you are supposed to give it(Required)

Have you signed your puppy up for pet insurance yet?(Required)

Yes

We will make sure that you get information to help you choose the best insurance plan for your friend and for your family

Are there other pets in your home?(Required)

Yes

Please tell us what pets share your home(Required)

As part of our personalized whole pet care, the following will help recommend what is best for your pet. Please check all that apply:

My puppy may be attending puppy kindergarten, training classes, daycare, or visit dog parks

There are children in my household

There are immunocompromised people in my household

There are wildlife or stray cats that visit my yard

My puppy will spend time outside in a fenced yard, on a leash, or on a deck

My puppy will spend time loose outside

My puppy will go to retail stores, pet stores, and/or stops with me at rest stops

My puppy will go camping, hiking, or hunting with my family

My puppy will go to boarding facilities or grooming facilities

My puppy will travel out of the state with me

My puppy will never leave the house (not even to go to the bathroom)

What questions or concerns do you have about your puppy?(Required)

Is there anything else you would like to know about raising a puppy?

I realize that no guarantee or warranty can ethically or professionally be made regarding outcomes of treatment of medical illnesses or effectiveness of preventative care products and procedures. I have been informed that there are certain risks and complications associated with disease, sedation, anesthesia, and/or any operation/procedure and that while the team at Healing Paws Veterinary Care, Inc has my pet's best interest in mind at all times, sometimes complications occur. I further understand that during the course of the examination, diagnostics, procedures, or treatments, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before treatment or diagnostics are initiated. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care. I accept that my financial obligations remain regardless of the outcome of treatment.(Required)

I have read and understand

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute consent for examination, diagnostic testing, procedures, and treatment of said animal. I have read and understand this authorization and hereby accept and agree to the terms of the consent for examination and treatment. I understand that I am financially responsible for any services, products, or treatments provided to my pet and that I can request a treatment plan and cost estimate for my pet at the time of my visit.(Required)

I have read and understand

My signature below certifies that I am over eighteen years of age(Required)

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Puppy’s First Visit History Form

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