New Client Intake Form

Welcome, and thank you for your interest in receiving pet care at Mount Joy Animal Clinic.

The information in this form will help speed up the process of creating your profile and will identify your current
pet concerns. We will follow up with you to book an appointment.

Pleasecall usfor any questions or technical issues with this form.

New Client Form

Owner Information

Please list all individuals who are authorized to make medical decisions regarding the patient
First name, last name, relationship with client
Which is your preferred mode of contact(Required)

Address(Required)

Pet Information

Sex
Indoor only? (cats)
Do you have copies of all latest vaccine certificates?
If so, please bring them with you to your appointment
Which medication/supplemnts is your pet taking? Please list:
Does your pet get human food? If so, which food?
Microchipped?(Required)
If no, do you want it to be done during the visit?
Please indicate your main concerns for the the visit and how long you've noticed the condition for.

Pet Health Survey

How is their behavior?(Required)
How is their eating?(Required)
How is their drinking?(Required)
How is their urination?
How is their bowel movement?
Mouth/teeth: Are any of the following symptoms present?
Check all that apply
Nose: Are any of the following symptoms present
Check all that apply
Eyes: Are any of the following symptoms present?
Check all that apply
Ears: Are any of the following symptoms present?
Check all that apply
Breathing: Are any of the following symptoms present?
Check all that apply
Gastrointestinal: Are any of the following symptoms present?
Check all that apply
Genitals: Are any of the following symptoms present?
Check all that apply
Coat/Skin: Are any of the following symptoms present?
Check all that apply
Legs/Paws: Are any of the following symptoms present?
Check all that apply
What language do you prefer the doctor speak?
Pet Photo Consent - Social Media
Pet Photo Consent - Website
If you give consent to the above, please provide your name and pet's name so that we can appropriately credit you and your pet!
This field is for validation purposes and should be left unchanged.

Learn about what to expect before your visit