Administrative
Veterinary Client Intake Form Template
Veterinary Client Intake Form Template
The client intake form is often a pet owner's first interaction with your clinic's administrative process. A well-designed intake form captures essential information efficiently, sets expectations, and demonstrates professionalism. This template covers everything you need for new client and patient registration.
When to Use This Template
- New client registration (first visit to your clinic)
- New patient addition (existing client with a new pet)
- Transfer of records (patient transferring from another clinic)
- Annual information update (yearly verification of contact details)
Template Preview
NEW CLIENT & PATIENT INTAKE FORM
[Clinic Name]
[Address] | [Phone] | [Website]
Date: _______________
SECTION 1: OWNER INFORMATION
| Field | Details |
|---|---|
| First Name | _______________ |
| Last Name | _______________ |
| Address | _______________ |
| City, State, ZIP | _______________ |
| Home Phone | _______________ |
| Cell Phone | _______________ |
| Work Phone | _______________ |
| Email Address | _______________ |
| Preferred Contact Method | ☐ Phone ☐ Text ☐ Email |
| Best Time to Reach You | ☐ Morning ☐ Afternoon ☐ Evening |
| Driver's License # | _______________ (for payment verification) |
Emergency Contact:
| Field | Details |
|---|---|
| Name | _______________ |
| Relationship | _______________ |
| Phone | _______________ |
Authorized Persons _(who may make medical decisions and authorize treatment for your pet):_
| Name | Relationship | Phone |
|---|---|---|
SECTION 2: PET INFORMATION
| Field | Details |
|---|---|
| Pet's Name | _______________ |
| Species | ☐ Canine ☐ Feline ☐ Other: _______ |
| Breed | _______________ |
| Color/Markings | _______________ |
| Date of Birth / Age | _______________ |
| Sex | ☐ Male ☐ Female |
| Spayed/Neutered | ☐ Yes ☐ No ☐ Unknown |
| Weight (approx.) | _______________ |
| Microchip # | _______________ |
How did you acquire this pet?
SECTION 3: MEDICAL HISTORY
Previous Veterinary Clinic:
| Field | Details |
|---|---|
| Clinic Name | _______________ |
| Veterinarian | _______________ |
| Phone | _______________ |
| ☐ Please request records transfer |
Vaccination Status:
| Vaccine | Date Last Given | Unknown |
|---|---|---|
| Rabies | _______________ | ☐ |
| DHPP / FVRCP | _______________ | ☐ |
| Bordetella | _______________ | ☐ |
| Leptospirosis | _______________ | ☐ |
| FeLV (cats) | _______________ | ☐ |
Is your pet currently on any medications?
| Medication | Dose | Frequency | Reason |
|---|---|---|---|
Known Allergies:
Has your pet ever had a reaction to vaccines or medications?
Current or previous medical conditions:
Previous surgeries:
SECTION 4: LIFESTYLE & ENVIRONMENT
Diet:
| Field | Details |
|---|---|
| Brand/Type of food | _______________ |
| Feeding schedule | ☐ Free-feed ☐ Twice daily ☐ Once daily ☐ Other: _______ |
| Treats | _______________ |
Living environment:
Other pets in household:
Flea/tick/heartworm prevention:
| Type | Product | Last Given |
|---|---|---|
| Flea/Tick | _______________ | _______________ |
| Heartworm | _______________ | _______________ |
SECTION 5: REASON FOR TODAY'S VISIT
Any specific concerns? _______________________________________________________________
SECTION 6: COMMUNICATION PREFERENCES
SECTION 7: POLICIES & ACKNOWLEDGMENTS
Signature: _______________ Date: _______________
Printed Name: _______________
Tips for Optimizing Your Intake Process
- Send forms in advance: Email intake forms with appointment confirmation so clients can complete them at home
- Keep it focused: Only ask for information you'll actually use
- Digital-first: Tablet-based or online forms save transcription time and reduce errors
- Privacy notice: Include a brief statement about how you protect client information
- Welcome packet: Pair the intake form with a welcome guide about your clinic
Where PetChart Fits
PetChart doesn't have online intake forms yet (a client portal with online booking is coming next), so use this template on paper or as a fillable PDF for now. Once you have the details, PetChart keeps them in one place:
- Client and pet records: the owner's contact details, and each pet's species, breed, date of birth, microchip and allergies
- Import from your old system: bring in existing clients, pets and vaccinations from spreadsheets
- Reminder preferences: owners who stop reminder emails are left out automatically
- Allergy warnings: allergies on the pet's record are checked every time someone prescribes
Get early access to PetChart and keep every client's details in one record.
Sources
- AAHA Standards
- AAHA Guidelines
- Use of technology in veterinary medicine (AVMA)
- Principles of veterinary data ownership and stewardship (AVMA)
Ready to put this into practice?
Tell us about your clinic and we'll set you up personally.
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