Patient History

For existing clients adding or updating a pet. We do not collect driver’s license or Social Security numbers online.

Patient History

For existing clients adding or updating a pet. This matches the clinic Patient History form.

Website

Pet name *

Owner last name *

Species *

Sex *

Spayed / neutered *

Feline combo tested

Breed *

Color / markings

Approx. age / date of birth *

Microchip # (if applicable)

Lifestyle *

Previous vet clinic

Do you have records?

What do you feed your pet? *

Wet / dry *

Approx amount (cups) *

How often? *

Heartworm prevention *

Heartworm prevention — other

Flea / tick prevention *

Flea / tick — other

Medical information — check all that apply

Allergies / ItchingAnal gland problemsAnxiety during storms / fireworksBehavioral changesWeight gain / lossChange in appetiteCoughing / sneezingExcess water intake / urinationEar infectionsSkin conditionPain / lamenessSeizuresBlood in urine / frequent or straining urinationDiarrheaVomiting

Itching — list area(s)

Growths — list location(s)

Previous surgeries and dates

Other

Currently on medications? *

Medications (name, dosage, frequency)

Drug allergies / adverse reactions

Geriatric bloodwork *

We recommend geriatric profiles for K-9's 7+ yrs & felines 9+ yrs. This bloodwork screens for diabetes, kidney/bladder disease and liver issues. Would you like us to perform today?

Family owned and operated in Bessemer since 2000.

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3051 Morgan Rd SE
Bessemer, AL 35022
(205) 426-2828
Mon–Fri 7:00–5:45
Sat 7:00–11:45
Closed Sunday

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Find your next step

Tell us what’s going on with your pet. We’ll point you to the right visit, form or call.

Tell us what you need

This points you to the right next step. It isn’t medical advice. For medical questions, call us. In an emergency, call us right away.