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I give Grand Avenue Veterinary permission to use photos of my pet for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content without payment or other considerations. *

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By signing below you acknowledge that payment is due at the time of service. All services agreed upon by both the Doctor AND the client which are performed are done so with the notion that payment will be provided for said services. We do not offer payment plans, but do accept third-party alternatives such as Care Credit and Scratch Pay. *

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Medical Records

Click or drag files to this area to upload. You can upload up to 10 files.

Your Signature *

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Date *

Your Pets

Pet's Name *

Age/Birthdate *

Type "N/A" if unknown

Species *

Dog
Cat

Breed/Color *

Sex *

Female
Spayed Female
Male
Neutered Male

This pet is: *

Indoor only
Outdoor only
Indoor/Outdoor

Past medical history or concerns *

Type "none" if no history or concerns

Has your pet been to another veterinarian in the last 12 months? *

Yes
No
Unknown

Name of Clinic *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Any blood tests done in the past 12 months? *

Do you have access to your pet's medical records? *

Yes
No

If not, can we contact your previous vet for them? *

Yes
No

Does your pet go to any of the following places:

Groomer
Daycare
Boarding
Dog Park

Any known allergies to medications or vaccinations? *

Yes
No

What do you feed your pet, and how often? *

Comments

Do you have second pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Age/Birthdate *

Type "N/A" if unknown

Breed/Color *

Sex *

Female
Spayed Female
Male
Neutered Male

This pet is: *

Indoor only
Outdoor only
Indoor/Outdoor

Past medical history or concerns *

Type "none" if no history or concerns

Has your pet been to another veterinarian in the last 12 months? *

Yes
No
Unknown

Name of Clinic *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Any blood tests done in the past 12 months? *

Do you have access to your pet's medical records? *

Yes
No

If not, can we contact your previous vet for them? *

Yes
No

Does your pet go to any of the following places: *

Groomer
Daycare
Boarding
Dog Park

Any known allergies to medications or vaccinations? *

Yes
No

What do you feed your pet, and how often? *

Comments

Do you have third pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Age/Birthdate *

Type "N/A" if unknown

Breed/Color

Sex *

Female
Spayed Female
Male
Neutered Male

This pet is: *

Indoor only
Outdoor only
Indoor/Outdoor

Past medical history or concerns *

Type "none" if no history or concerns

Has your pet been to another veterinarian in the last 12 months? *

Yes
No
Unknown

Name of Clinic *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Any blood tests done in the past 12 months? *

Do you have access to your pet's medical records? *

Yes
No

If not, can we contact your previous vet for them? *

Yes
No

Does your pet go to any of the following places: *

Groomer
Daycare
Boarding
Dog Park

Any known allergies to medications or vaccinations? *

Yes
No

What do you feed your pet, and how often? *

Comments

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