Pet Registration Form

Thank you for giving us the opportunity to care for your pet. So that we may become better acquainted, please complete and submit the following form.

Owner's Name
Spouse/Housemate's Name
Pet's Name
Breed
Birth Date
Species
- Dog
- Cat
Gender
- Male
- Female
Spayed/Neutered?
- Spayed
- Neutered
- Not spayed or neutered
Colors
Where did you get your pet?
Breeder? Pound? Friend? Other?
Is your pet on heartworm and/or flea prevention?
- Yes
- No
If yes, which ones?
What do you feed your pet?
Prescription? Commercial? Table scraps?
Do you supplement with treats, vitamins, etc?
- Yes
- No
If yes, which ones?
Is your pet
- Inside only
- Inside/Outside
- Outside only
If outside, how many hours per day?
The area they are outside is
- Fenced
- Unfenced
History
Please share your pet's history - ongoing health problems (include current medications), allergies, prior illness or trauma, behavior problems, personality "quirks," etc. Also, please let us know about any concerns you have regarding your pet.
Current Medications other than heartworm and flea/tick prevention:
Drug
(ex: Rimadyl)
mg (if known)
(ex: 25mg)
Frequency
(ex: 1 tablet twice a day)
Photo Release
As his/her owner I give permission for my pet to be photographed and he/her likeness used on the Healing Paws Veterinary Hospital website, Facebook page, or other media.
Owner's Name

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Pet Registration Form

Current Medications other than heartworm and flea/tick prevention:

Photo Release