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New Patient History

MedVet Houston Bay Area - Cardiology, Internal Medicine, Oncology and Surgery

Please help us obtain as much information about your pet as possible by completing this form. The veterinarian will review this form with you at the time of your pet's appointment.

Your Information


Your Pet

Medical Information

Does your pet live
Has your pet ever had ticks?
Does your pet have any previous diagnosis of chronic disease(s)?
Is your pet on heartworm preventative?
Has your pet ever been diagnosed with heartworm disease?
Is your pet sensitive or allergic to any medications?
Has your pet experienced any of the following in the past 6 to 8 weeks?
Changes in appetite*
Changes in bowel movements*
Abnormal urination*
Abnormal thirst*
Abnormal respiration*
Nasal discharge*
Any other discharge*
Any swelling or lumps*
Bleeding from anywhere*
Abnormal gait or lameness*
Fever detected by thermometer*
Changes in attitude or activity level*
Weight loss*
Changes in environment*
Exposure to toxins, pesticides, rat poison or coumadin*
Seizures, fainting or collapse*
Changes in vision, smell or hearing*
Has your pet experienced any of the the following in the past 6 to 8 weeks?