Animal Medical History Form
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1Animal Medical History
PET 1
PET 2
PET 3
Please complete all information for each pet.
Name
Cat, Dog or Other
Breed
Description (color)
Age (years)
Date of Birth (if known)
Sex (M or F)
Altered ( Neutered or Spayed)
Is your pet Indoor, Outdoor or Both?
is your pet on any medications?
Has your pet had any reactions to
medications or allergies?
Vaccinations
DHLP (distemper - dog)
Parvovirus (dog)
FVRCP (infectious disease - cat)
Rabies ( dog/cat)
Feline Leukemia Vaccination
Other Vaccines
Heartworm Test/Medication
Last Fecal Exam (worms -dog/cat)
Dentistry
Prior Illness
Prior Surgery
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Parent category: Medical