Pet'S Medical History
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1Pet’s Medical History
Name:________________________________ Breed:_________________________________
Birthdate (approx if unknown):___________ Time Owned:_________ Color:____________
Sex: Male [ ] Female [ ] Is your pet spayed/neutered: Yes [ ] No [ ]
Native to Arizona? Yes [ ] No [ ] State(s) pet has traveled to:_________________________
Type of diet:_______________________ Other Pets:_________________________________
Dates of Last Vaccines
Dog
Date
Cat
Date
Ferret
Date
Rabies
Rabies
Rabies
DA2PP
FVRCP
Distemper
(Parvo Distemper
(Upper Respiratory
combo)
Distemper combo)
Feline Leukemia
Bordetella
Virus
(Kennel Cough)
Lyme
FIP
Dates of last Diagnostic Tests:
Dogs and cats:
Fecal exam for parasites:_________
Heartworm test:__________
Cats only:
Feline Leukemia Virus Test:__________ Feline Immunodeficiency Virus Test:___________
Other medical history:
Previous medical problems/medications: __________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Any known allergies (to what): ___________________________________________________
Is your pet Microchipped? Yes [ ] No [ ] If yes, what is the ID#_______________________
If no, would you like us to Microchip your pet for you? Yes [ ] No [ ]
Desert Hills Pet Clinic
Tucson, AZ
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Parent category: Medical