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Online Forms

Patient History Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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Patient History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 208-233-6840 for a faster response.

Name *

First

Last

Name of person bringing patient in for appointment, and who is to authorize treatments.

Phone *

Email *

Appointment Date/Time *

Date

Time

Are vaccinations current? *

Yes, done here
Yes, done elsewhere
No
I don't know

Where were pet's last vaccinations given? *

Please list the clinic name, city, and state where last vaccines were given.

Patient's Species *

Canine
Feline
Other

If other, please specify *

Patient's Sex *

Male
Neutered Male
Female
Spayed Female

Primary Reason for Appointment/Concerns *

Patient's Energy Level *

Normal
Increased
Decreased

Is Patient on Heartworm Prevention or Flea/tick prevention? *

Heartworm Prevention Only
Flea/Tick Prevention Only
Both Heartworm and Flea/Tick Prevention
Neither
I'm not sure

Patient's Medications *

Please list all current medications including supplements and CBD products

Do you need refills on any of these medications and, if so, which ones? *

Type n/a if you don't have any medications or need a refill

What type/brand of food does the patient eat? Please include people food and treats. *

Patient's Appetite *

Normal
Increased
Decreased

Drinking/Water Intake *

Normal
Increased
Decreased

Is the patient coughing? *

Yes
No
I'm not sure

Is the patient sneezing? *

Yes
No
I'm not sure

Is the patient vomiting? *

Yes
No
I'm not sure

Does the patient have diarrhea? *

Yes
No
I'm not sure

Patient's Urination *

Normal
Increased
Decreased
Dark
Blood present
Cloudy
Straining to urinate
Strong/foul odor
Other

Please select ALL that apply

If other, please specify *

If patient is having any symptoms how long have they been going on?

Any previous history for this patient we should be aware of?

Do you have CareCredit or Pet Insurance? *

CareCredit
Pet Insurance
Both
Neither
I would like more information

Come in for superior care and excellent service.

We have a state of the art veterinary facility which is clean, comfortable, and efficient. Call (208) 233-6840 to book an appointment or click on the button below and we will find a time that is convenient for you.

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