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
Digitize Client Intake with PetChart
PetChart transforms the intake process from paper-heavy to seamless:
- Online pre-registration: Clients complete intake forms through the client portal before their visit
- Smart forms: Conditional logic shows relevant questions based on species and visit type
- Automatic record creation: Form responses create patient and client records instantly — no data entry
- Medical history import: Request and receive records from previous veterinary clinics digitally
- SMS consent: Capture communication preferences and opt-ins automatically
- Returning client updates: Prompt clients to verify and update their information annually
Start your free PetChart trial and eliminate intake paperwork forever.
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?
Sign up for PetChart and get started today.
More in Administrative
Clinical
Veterinary Discharge Instructions Template
Free veterinary discharge instructions template for post-surgical care, medication schedules, and follow-up guidance. Improve client compliance and outcomes.
Clinical
Veterinary SOAP Notes Template (Free Download)
Free downloadable SOAP notes template for veterinary professionals. Standardize your clinical documentation with this comprehensive format.
Clinical
Veterinary Surgical Safety Checklist Template
A downloadable surgical safety checklist for veterinary practices, based on AAHA Anesthesia and Monitoring Guidelines and adapted from the WHO Surgical Safety Checklist.