Patient History Form Canine

Thank you for dropping off your pet with us today! The following information will be used to help our veterinary team care for your pet and begin a treatment plan.

Patient Name*
Birthday/Age (if known)*
Spayed/Neutered*
- Yes
- No
Is you pet here for vaccines?*
- Yes
- No
If yes, are there any concerns you would like the doctor to address? Please be specific, we may still call you with additional questions based on the i nformation provided.
Do you need any prevention today? (heartworm/flea prevention) If so how many months would you like?
If they are not here for vaccines what issue are you concerned about? Please be specific, we may still call you with additional questions based on the information provided.
How long has this been going on for?
Have you noted any changes in their eating or drinking habits? If so, what are they?
Have you noted any changes in their urinary or defecation habits? If so, what are they?
Have they received their monthly dose of flea/heartworm prevention within the past 30 days? What brand of prevention are they currently on?
What brand of food are they currently eating? How much food in one day?
What brand of food are they currently eating? How much food in one day?
Have you noted any behavior changes recently, and if so, what are they?
Has there been any changes with their regular routine or environment recently?
Has their activity level changed recently?
Do they go to dog parks or doggie day care?

Let’s Get in Touch!

Name: Heights Veterinary Clinic
Address: 4107 Sherwood Lane, Houston, TX, 77092, US
Telephone: (832) 982-2365
Price range: $$

We always welcome new clients and patients to our full-service veterinary clinic in Houston, Texas. We look forward to meeting you and your pet!

Heights Veterinary Clinic-Northwest

Address
4107 Sherwood Lane,
Houston, TX 77092

Contact
Phone: (832) 982-2365

Call now Directions

Hospital Hours
Monday – Friday 7:30am-6:00pm
Saturday 8:00am-12:00pm
Sunday Closed

Doctor Hours
Monday – Friday 8:00am – 11:30am, 2:00pm – 5:30pm
Saturday – 8:00am -11:30am