Call Us : (416) 485-7779
LawrenceParkAH@gmail.com

New Patient

    Patient Information:

    Client's Name (required)

    Patient's Name (required)

    Your Email (required)

    Sex (M=male, N=neutered male, F=female, S=spayed female)

    Species

    Breed

    Birthday

    Colour

    Microchip number yes/no, if yes #

    Vaccination Information:
    CANINE:

    Rabies (date given)

    DA2PP (distemper, adenovirus, parvovirus, parainfluesna) (date given)

    Bordetella (date given)

    Leptospirosis (date given)

    Heartworm Test (date)

    Fecal Test (date)

    De-worming (date)

    FELINE:

    Rabies (date given)

    FVRCP (date given)

    Leukemia (date given)

    Fecal Test (date)

    Current Diet:

    Please liste any current medication(s)

    Any previous illness/injury or surgery

    Any known allergies/reactions to vaccinations or medications?

    Pet insurance? Yes/no if yes, name of the company:

    Previous Veterinarian (so we may obtain previous medical records):

    Please provide us with further information regarding your experience with dogs (i.e. you grew up with dogs but this is YOUR first dog, etc.):