Client Forms – Kindness Animal Hospital

Forms and Documents for Pet Parents

Expedite your check-in at Kindness Animal Hospital by preparing your forms in advance! Not sure what you need to fill out before you visit? Reach out to our helpful staff, and they’ll be happy to guide you to the correct forms. We look forward to seeing you and your pet!

Client Check-In Form

First Name

Last Name

Phone Type

Cell Home Work Fax

Phone Number

Email Address

Have you visited our hospital previously?

Yes (Welcome back!) No (Welcome, and please fill out the online new client form and submit prior to arrival)

Pet's Name

Please tell us below why your pet is coming in for an appointment:

Has your pet had an episodes of vomiting/diarrhea/changes in urination/coughing? Have there been changes in thirst or urination? Any coughing or sneezing?

Is your pet still eating normally? If not, please give details of duration.

Please list your pet's current medications below (name and how often medication is given)?

Do you need any medications refilled? If yes, which medications do you need refilled before your appointment?

Does your pet have a history of vaccination reactions?

Diet Information

Please list below the brand of food you currently feed your pet:

How much do you feed your pet? (ie: 1/2 cup twice daily)

Check below which type of heartworm/intestinal parasite control you apply/give orally to your pet monthly:

Interceptor Plus Chew HeartGard Plus Chew Other My pet does not receive monthly heartworm/intestinal parasite control

If you selected 'Other' (please tell us what heartworm/intestinal product you give/apply monthly):

Check below which type of flea/tick control you apply/give orally to your pet monthly:

If you selected 'Other' (please tell us what flea/tick control product you give/apply monthly):

Outside Cats

Please check this box if your pet is a feline patient who goes outside.

Peanut Allergies

Please check the box below if there are any peanut allergies in your household or if your pet has any food allergies

Do you have any questions or concerns for your veterinarian which you have not mentioned above?

Prescription Refills

First Name

Last Name

Street Address

Street Address 2

City

State / Province

Zip / Postal Code

Email Address

Daytime Phone

Phone Type

Evening Phone

Phone Type

Pet's Name

Age: Years, Months

Sex

Male Female

Have we seen your pet within the last year?

Yes No

Medication Requested

Additional Comments / Questions