Patient History Form

At All Paws Animal Hospital, we offer our patient history form online so you can complete it in the convenience of your own home or office. Please fill out thoroughly and submit prior to your scheduled appointment.

Patient Name:*
Owner Name:*
Address:*
Email:*
Best phone number:*
Date:

What kind of food are you feeding? How much? How often? Include treats and human foods.

Has there been any of the following:
VomitingDiarrheaCoughingSneezingScratchingChange in skin or haircoatShaking the headLamenessLethargyLumps/bumpsChange in appetiteChange in water consumptionChange in urinary habits

If any of the above are abnormal, please provide more detail.

Has your pet ever had a reaction to any vaccination/medication? If so, what product and what was the reaction?

Current flea/tick preventive – product and last administration date:

Current heartworm preventative – product and last administration date:

Is your pet currently being treated for any chronic medical condition? If yes, please list the condition(s) and treatment(s).

Are there any other concerns/problems for the doctor to address?

Please list any other medications, supplements, joint supplements, home remedies, etc. that are currently being used – product, dose, and last administration date:

Do you need any product today? (flea/tick/heartworm preventative, treats or food, joint supplements, shampoo, etc.)


Please prove you are human by selecting the Truck.