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Veterinary Intake Form Template

Streamline Your Pet Information Gathering with Our Template

Gathering essential information from pet owners can be a challenge in busy vet clinics. This veterinary intake form template is designed to help you efficiently collect crucial data about pets, making the intake process smoother for both your staff and clients. With this customizable form, you can quickly capture details such as medical history, allergies, owner contact information, and vaccination records, enhancing your clinic's workflow and ensuring quality care. Plus, its WCAG-aligned labels make it accessible for everyone. Try using our live template today and simplify your client onboarding!

Use this Template (FREE) Live Preview
Owner full name
Email address
Primary phone number
Mailing address
Emergency contact (name and phone)
Reason for visit
Wellness exam
Vaccination
Illness or injury
Surgery consultation
Dental care
Preventive testing
Behavior concern
Second opinion
Other
Please Specify:
Brief description of your pet's current concern or request
Preferred appointment date
How soon do you need this appointment?
Routine (next available)
Soon (within 48 hours)
Urgent (same day if possible)
Pet name
Species
Dog
Cat
Rabbit
Bird
Reptile
Small mammal
Other
Please Specify:
Age (years and months, approximate if unknown)
Sex
Female
Male
Unknown
Spayed or neutered
Yes
No
Vaccination status
Up to date
Some overdue or unknown
Not vaccinated
Not applicable
Current symptoms (select all that apply)
Please Specify:
How long has the current issue been present?
Less than 24 hours
1-3 days
4-7 days
1-4 weeks
More than a month
Intermittent or recurring
Not applicable
Current medications or supplements (name, dose, frequency)
Known allergies or adverse reactions
Do we have your permission to request previous veterinary records?
Yes
No
Your pet's typical behavior during exams
Relaxed or cooperative
Anxious
Fearful
May bite or scratch
Unknown
Has your pet ever bitten or scratched causing injury?
Yes
No
Handling aids or accommodations needed (if any)
None
Extra time
Muzzle
Sedation recommended
Lift assistance
Other
Please Specify:
Primary diet
Dry kibble
Wet or canned
Raw or home-prepared
Prescription diet
Mixed
Treats or table scraps
Other
Please Specify:
Does your pet have insurance coverage?
Yes
No
Consent to examination and treatment
Yes
No
If we cannot reach you in an urgent situation, do you authorize necessary treatment?
Yes
No
I accept financial responsibility for all services rendered
Yes
No
Typed signature (full name)
Signature date
Communication preferences
Appointment reminders by text
Appointment reminders by email
Health tips or newsletter
Promotional offers
Do not send marketing communications
{"name":"Owner full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Owner full name, Email address, Primary phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a veterinary intake form for a digital template article.

When to use this form

Use this intake form when you need complete patient and owner details before exams, surgeries, or drop-offs. It helps clinics, mobile vets, and shelters capture history, consent, and safety notes in one pass. Ask clients to complete it from home to shorten lobby time and prepare your team for triage. For ongoing medical notes and follow-up plans, pair it with the Veterinary EMR form. If your staff also coordinates boarding or home care, keep feeding and medication instructions aligned with the Pet sitting pet form.

Must Ask Veterinary Intake Questions

  1. What is your pet's full identification (name, species, breed, sex, age, color, and microchip number)?

    This confirms the right chart, dosing, and lab ranges for the patient. Clear identifiers prevent mix-ups, especially in multi-pet households or rescue settings.

  2. What brings you in today? Describe symptoms, when they started, and any changes.

    Onset and progression help set urgency, triage, and the exam plan. Specific signs guide which diagnostics are most likely to help first.

  3. What medications, supplements, and parasite preventives is your pet taking, and are there any drug or food allergies?

    Knowing current products avoids dangerous interactions and informs safe treatment choices. Preventive use and timing also help rule in or out likely causes.

  4. Do we have permission to access prior veterinary records, and what is the previous clinic's contact info?

    Past labs, imaging, and vaccine dates prevent duplicate costs and speed care decisions. If you manage digital charts, align this consent with the Veterinary EMR form.

  5. How does your pet behave during exams and handling (bite risk, muzzle use, stress triggers)?

    Behavior notes let your team handle safely, reduce fear, and plan low-stress visits. For ongoing behavior goals or referrals, you can collect details with the Dog training form.

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