Template

New Client & Patient History Form (Veterinary Intake Form)

Updated 25 Oct 2026

An intake form for new clients: owner details, pet details, diet, medications, vaccination and parasite-control history, and consent to contact.

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Preview

Clinic name

Address · Phone · Email

New client & history form

Owner

Full name

Phone

Address

Emergency contact

How did you hear about us?

Pet

Name

Species / breed

Date of birth / age

Sex / neutered?

Colour / markings

Microchip no.

History

Diet (brand, amount, treats)

Current medications & supplements

Last vaccination (date & which)

Parasite control (product & date)

Past illnesses, surgeries, allergies

Reason for today's visit

I agree that the clinic may contact me by phone, SMS, WhatsApp or email about my pet's care and reminders.

Owner — name & signatureDate

Template from WeVet — free veterinary resources

Frequently asked questions

Is this new client & history form template free?

Yes. You can see the whole template on this page. Downloading it for Word / Google Docs or saving it as a PDF needs a free WeVet account.

Can I add my clinic's name and logo?

Yes. Download the Word version and edit it — the clinic details at the top are blank fields.

Is the wording legally approved for my country?

No template can be. Adapt consent and record wording to your national veterinary council and local regulations before using it.

Have a case in front of you?Ask WeVet — the AI assistant built for veterinarians. Differentials, treatment plans with calculated doses, drug info from trusted sources and SOAP notes.

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