Veterinary Patient History Form

This is a 100% free and printable template for veterinary practices. Use this form to gather a comprehensive medical history of the patient and provide more accurate and effective care. Print it or download it as a PDF.

Veterinary Clinic

Patient History Form

Today's Date:
Owner's Name:
Preferred Phone #:
Patient Name:
Species & Breed:
Sex:
Age:

Past Illnesses, Surgeries, and Treatments

Current Medications and Allergies

Family Medical History (if relevant)

Lifestyle Factors (diet, exercise, environment, exposure to smoke, etc.)

Symptoms in Different Parts of the Body (Please check all that apply):

☐Skin/Coat (itching, rashes, lumps, hair loss)
☐Eyes/Ears (discharge, redness, hearing or vision changes)
☐Respiratory (coughing, sneezing, difficulty breathing)
☐Gastrointestinal (vomiting, diarrhea, changes in appetite)
☐Musculoskeletal (limping, stiffness, weakness)
☐Neurological (seizures, disorientation, head tilt)
☐Urinary (difficulty urinating, blood in urine)
☐Behavioral Changes (aggression, anxiety, changes in routine)

Additional Details or Observations

Owner's Signature:
Staff's Signature:

Download or print this template under the Customize Template section.

A Patient History Form is a document used by veterinary professionals to collect vital information about a pet’s medical background and lifestyle. This includes past illnesses, surgeries, medications, family history, and any current symptoms.
It helps the veterinarian understand the pet’s overall health context, identify patterns, diagnose conditions more accurately, and recommend appropriate treatments or preventive measures.
The pet owner or an authorized caregiver is responsible for completing the form. Their knowledge about the pet’s habits, symptoms, and past medical events is crucial for accurate veterinary assessment.
Typically, this form is completed for new patients, at annual wellness exams, or whenever there has been a significant change in the pet’s health. Keeping these records up to date helps ensure continuity of care.

Other Forms

Customizable veterinary forms for your clinic. 100% free, printable and downloadable as PDF.

Veterinary Against Medical Advice Form (AMA)

This form is used to allow the owner to decline any/all medical treatments/procedures and provide a record of the decision.

Veterinary Anesthesia Consent Form

This form is used to obtain the owner's or authorized agent’s consent for administering anesthesia, sedation, and any necessary surgical or medical procedures.

Veterinary Consent Form

This form is used to obtain the owner's permission for veterinary procedures and to acknowledge the associated risks, responsibilities, and payment obligations.

Veterinary Euthanasia Consent Form

This form is used to get informed consent from the owner to perform euthanasia on their pet and highlight the legal, medical, and ethical considerations of the procedure.