Intake

Veterinary Clinic Intake Form

2 pages14 fieldsHIPAA-ready

Form preview

formisoft.com/f/veterinary-clinic-intake
Pet Owner Full Name
Phone Number
Email Address
Emergency Contact
Contact person
Pet Name, Species & Breed
Pet Date of Birth / Age
Spay/Neuter Status & Weight
Select...
Vaccination History
Diabetes
Hypertension
Asthma
Heart Disease
Current Medications
Known Allergies
Reason for Visit
Prior Vet Records Upload
Upload file
Pet Insurance Information
Insurance carrier & policy
Treatment Consent & Signature
I agree to the terms above
Sign here
Submit

The Veterinary Clinic Intake Form is purpose-built for veterinary practices, animal hospitals, and mobile vet services that need to collect comprehensive pet and owner information before an appointment. This vet clinic new client form captures pet owner demographics, emergency contact details, pet species and breed identification, weight, age, spay/neuter status, and a detailed vaccination history including rabies, distemper, bordetella, and other core and non-core vaccines. The form also screens for current medications, known allergies, and dietary information so the veterinary team is fully prepared before the animal enters the exam room.

Designed to streamline the veterinary patient intake process, this template includes fields for prior veterinary records, behavioral notes such as anxiety triggers or aggression history, and a detailed description of the reason for today's visit. Pet owners can list multiple pets on a single submission, indicate whether the visit is for a wellness check, illness, injury, or follow-up, and upload any relevant documentation such as previous lab results or referral letters. The insurance information section supports pet insurance providers so the front desk can verify coverage before the appointment begins.

Whether you run a small-animal general practice, an exotic animal clinic, a large-animal veterinary hospital, or an emergency veterinary service, this intake form reduces front-desk paperwork and ensures consistent, thorough data collection for every new client. The consent agreement covers treatment authorization, payment responsibility, and acknowledgment of clinic policies, giving your practice the documentation it needs while providing pet owners with a smooth, professional onboarding experience.

What's included

  • Pet owner demographics and emergency contact collection
  • Pet species, breed, weight, and age identification
  • Vaccination history checklist with core and non-core vaccines
  • Current medications and known allergies documentation
  • Prior veterinary records upload and referral information
  • Pet insurance verification fields
  • Treatment authorization consent agreement with e-signature
  • Structured medication list with dosage and frequency tracking
  • Insurance information collection with carrier and policy details
  • Allergy documentation with severity levels
  • Medical conditions checklist

Who uses this template

  • Small-animal veterinary practices onboarding new clients and their pets
  • Emergency and specialty veterinary hospitals collecting intake data quickly
  • Mobile veterinary services gathering pet and owner information before house calls
  • Exotic animal and large-animal clinics standardizing new patient registration

All form fields

14 fields across 2 pages. Customize any field after signing up.

Pet Owner Full NameText
Phone NumberPhone
Email AddressEmail
Emergency ContactEmergency Contact
Pet Name, Species & BreedText
Pet Date of Birth / AgeDate
Spay/Neuter Status & WeightDropdown
Vaccination HistoryConditions
Current MedicationsMedications
Known AllergiesAllergies
Reason for VisitLong Text
Prior Vet Records UploadFile Upload
Pet Insurance InformationInsurance Info
Treatment Consent & SignatureConsent Agreement

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$79.99/mo · Cancel anytime · HIPAA compliant

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