Email(Required)

Primary Phone(Required)

Secondary Phone

Phone(Required)

Email(Required)

How did you find out about our hospital? If you were referred by someone, who should we thank?(Required)

Where has your pet received veterinary care in the past?(Required)

Where and how long ago did you acquire your pet?(Required)

Pet's Name(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

What is your pet's hair/fur coat color?(Required)

Age/Date of Birth(Required)

Please list all Veterinary Practices and phone numbers where your pet has been seen in the past 24 months.

What is the microchip number?(Required)

Attach photo of medical records

Drop files here or

Max. file size: 50 MB, Max. files: 10.

Behavioral Questionnaire

How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)(Required)

Does your pet have any allergies? If yes, explain.(Required)

Does anyone else in your family have any allergies that we should be aware of? If yes, explain.(Required)

How would you describe your pet around other animals and people?(Required)

Does your pet have any sensitive areas that s/he does not like to have touched by you or others?(Required)

Are there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) If so, how did your pet react?(Required)

What are your pet’s favorite treats? (Please bring some to your next visit to our hospital):(Required)

Does your pet like to play with toys? If so, what kinds?(Required)

Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?(Required)

Anything else you would like us to know?(Required)

Signature(Required)

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New Client Form

Welcome new clients!

New Client Form

Behavioral Questionnaire

Ready for a visit?

Questions? Get in touch.

Fort Greene

Flatbush