1. Templates
  2. Pets & Veterinary
  3. Veterinary Practices
  4. Pet Medical History & Intake Form

Pet Medical History & Intake Form

A medical history template — conditions, medication, vaccinations and diet captured, so the vet has your pet’s full picture before treating.

Description

A vet treats better when they know the whole pet, and this intake builds that record. It gathers your pet’s medical history in one place — past and current conditions, medication, allergies, vaccinations, surgeries and diet — so the clinical picture is complete before examination or treatment. It works through what the vet needs on file: ongoing conditions and medication with doses, known allergies or reactions, previous operations, vaccination and parasite-treatment status, diet and weight, and reproductive status. The kind of history that helps a vet connect the dots rather than treat in the dark. Use it at registration or before a first consultation. Free, brandable, and it means your pet’s first appointment with a new vet starts from knowledge, not a blank page.

Form fields

Everything the Pet Medical History & Intake Form above collects — 13 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Your Pet's Medical History

  • Pet's name

    Short Answer Icon
    Short Answer
  • Species

    Dropdown Icon
    Dropdown
  • Current conditions & medication (name, dose, frequency)

    Long Answer Icon
    Long Answer
  • Known allergies or reactions (incl. to medication/anaesthetic)

    Long Answer Icon
    Long Answer
  • Previous illnesses or surgeries

    Long Answer Icon
    Long Answer
  • Vaccinations up to date?

    Yes/No Icon
    Yes/No
  • Last flea / worm treatment

    Date Icon
    Date
  • Diet & approximate weight

    Long Answer Icon
    Long Answer
  • Reproductive status

    Dropdown Icon
    Dropdown

Your details

  • Your name

    Name Icon
    Name
  • Contact number

    Telephone Icon
    Telephone
  • Email address

    Email Icon
    Email
  • Accurate history

    Consent Icon
    Consent
Use Template Arrow Right Icon

Template FAQs

Common questions about the Pet Medical History & Intake Form — what it captures, when to use it, and how to make it your own.

Why does the vet need my pet's full medical history?

Because past conditions, reactions and treatments shape safe care today — a drug allergy, a heart murmur, a previous operation all matter. A complete history lets the vet treat your pet safely and spot patterns.

What does the intake cover?

Current and past conditions, medication and doses, allergies or reactions, previous surgeries, vaccination and parasite-treatment status, diet and weight, and reproductive status — the full clinical picture.

Why do allergies and reactions matter so much?

Because a reaction to a medication or anaesthetic can be serious. Recording known allergies and past reactions means the vet avoids them and keeps your pet safe during treatment.

Should I include diet and weight?

Yes — diet and weight affect health and influence drug doses and treatment plans. They’re a genuine part of your pet’s medical picture, not an afterthought.

What if I don't know all my pet's history?

Share what you can — especially for rescues, full history isn’t always available. The vet works with what’s known and can request records from a previous practice to fill gaps.

Is the intake form free?

Yes — free with a Fun Forms account, fully customisable, and ready to embed or share as a link.