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Pet Exam Form Template

Streamline Your Veterinary Visits With This Easy Template

Keen to keep pets healthy but feel overwhelmed by paperwork? This pet exam form template is designed for veterinarians and pet care professionals who want to simplify the examination process, ensuring no vital signs are overlooked. You'll benefit from a structured format that enhances accuracy in assessments, saves time during consultations, and improves communication with pet owners, all while adhering to industry standards. Experience its effectiveness by trying the live template today.

Use this Template (FREE) Live Preview
Your full name
Email address
Mobile phone number
Preferred appointment date
Preferred contact method
Phone call
Text message
Email
Any
Pet name
Species
Dog
Cat
Rabbit
Bird
Reptile
Small mammal
Other
Please Specify:
Approximate age
Sex and reproductive status
Male - intact
Male - neutered
Female - intact
Female - spayed
Unknown
Is your pet microchipped?
Yes
No
Is this your first visit to our clinic with this pet?
Yes
No
Primary reason for the free exam today
New pet wellness check
General health check
Vaccine discussion
Behavioral concern
Skin or ear issue
Gastrointestinal issue
Mobility or pain concern
Dental check
Other
Please Specify:
Describe any current symptoms or concerns
How long has this issue been present?
Less than 24 hours
1-3 days
4-7 days
1-4 weeks
Over 1 month
Not applicable
Current symptoms (select all that apply)
Known medical conditions (select all that apply)
Please Specify:
Current medications or supplements (name, dose, frequency)
Are core vaccinations up to date?
Yes
No
Some/unsure
Not applicable
Parasite prevention (heartworm, flea, tick)
Year-round prevention
Seasonal prevention
Intermittent/when needed
None
Not sure
Has your pet had a heartworm test in the past year?
Yes, within 12 months
Yes, over 12 months ago
No
Not sure
Not applicable
Primary diet type
Commercial dry kibble
Commercial canned
Prescription veterinary diet
Raw or home-prepared
Mixed
Other
Please Specify:
Home and lifestyle (select all that apply)
Indoors only
Mostly indoors
Indoors and outdoors
Mostly outdoors
Multi-pet household
Children in home
Boarding/daycare exposure
Behavior concerns to discuss (select all that apply)
Anxiety or fear
Aggression
House soiling or litter issues
Excessive vocalization
Destructive behavior
Leash reactivity
None
Other
Please Specify:
Primary veterinarian or clinic name (if any)
May we request medical records from your previous veterinarian?
Yes
No
How did you hear about the free exam?
Clinic website
Social media
Online search
Friend or family referral
Rescue or shelter
Community event
Other
Please Specify:
I understand the free exam covers the examination only; treatments, diagnostics, vaccines, and medications are additional.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I agree to pay for any authorized services not included in the free exam promotion today.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
May we use your pet's photo or story for clinic educational or social media purposes?
Yes
No
If we cannot reach you during the visit, may we provide necessary care up to a limit you set?
Yes, up to the limit specified below
Yes, any necessary care
No, contact me first
Authorization cost limit (USD)
Emergency contact name (other than you)
Emergency contact phone
I confirm the information provided is accurate to the best of my knowledge.
True
False
Type your full name as signature
Signature date
Preferred reminder method for future care
Text message
Email
Phone call
Any
{"name":"Your full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Your full name, Email address, Mobile phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration featuring a pet exam form with various fields and checkboxes for data collection

When to use this form

Use this veterinary physical exam template for routine checkups, new patient assessments, pre-surgery clearances, and follow-ups. It helps you gather the chief complaint, history, medications, vaccines, and vitals before the appointment, so you can focus on care. Small clinics, mobile vets, and shelters can send it ahead to cut lobby time and reduce missed details. Pair it with the Veterinary intake form for first-time clients, and request the Dog health certificate form when travel, boarding, or daycare needs proof. Rescue teams can attach exam notes to adoption files for faster approvals and fewer callbacks.

Must Ask Pet Exam Questions

  1. What is the main reason for today's visit?

    This chief complaint sets your priorities and flags urgent issues for triage. Clear detail guides targeted exams, diagnostics, and client education.

  2. What are your pet's name, species, breed, age, and sex?

    Signalment shapes differentials, dosing, and risk. It also keeps records consistent across visits; if details change, use the Dog bio update form to update the chart.

  3. What medications, supplements, and preventives is your pet currently taking?

    Accurate lists prevent drug interactions and duplicate therapies. Knowing doses and timing informs anesthesia, pain control, and test selection.

  4. When were the last core vaccines and parasite prevention given? Include dates and product names.

    Up-to-date status guides what is due today and your risk assessment for infectious disease. Exact products and dates also support travel, grooming, and public health requirements.

  5. Is this exam part of an adoption or intake process? If so, which rescue or shelter and case ID?

    Linking the visit to adoption paperwork avoids gaps and repeat questions. For dog placements, align answers with the Dog adoption application form to keep files in sync.

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