New Canine/Feline New Pet Form Congratulations on your new pet. Please fill in the information so that we can add your pet to our system and create their patient file. Please contact our office at (610) 367-4744 if you have any questions. Pet's Name* First Last Sex* Male Female Male Neutered Female Spayed Unknown Birthday or Approximate Age*Species* Canine Feline Avian Ferret Mouse/Rat/Rodent Reptile/Amphibian Rabbit Gerbil/Guine Pig/Hampster Breed*Color*If your pet has a microchip or permanent identification please type their ID for our records.At what age was your pet when you obtained him/her?Please list any allergies that your pet has:What diet are you currently feeding your pet?Where did you obtain this pet?* Friend Breeder Pet Shop Humane Society Other Photo Authorization Form* Yes, I authorize Gilbertsville Veterinary Hospital to take and use photos of my pet. I understand that these photos may be used on social media platforms, hospital marketing materials and the Gilbertsville Veterinary Hospital website. No, I do not authorize Gilbertsville Veterinary Hospital to take or use photos of my pet. Medical Record Release* Yes, I authorize Gilbertsville Veterinary Hospital to provide my pet's medical records to requesting third parties. No, I do not authorize Gilbertsville Veterinary Hospital to release my pet's medical records to requesting third parties without my consent. Please list any alerts that our team should be aware of (examples: needs a muzzle, does not like cats, does not like dogs, etc.)Has your pet had any prior illness or surgical procedures in the past? Please describe below.Is your pet currently taking any medication?Feline Question only: Is your pet declawed? If so, front only or all 4 paws?Reason for your pet's visit? Please describe below.Please list any questions or concerns that you have for our veterinarians or team members.List your previous veterinary hospitalI authorize Gilbertsville Veterinary Hospital to contact my previous veterinary hospital to obtain my pet's medical history. Yes No No previous history Upload your pet's vaccine and medical history Submit a Comment Cancel replyYou must be logged in to post a comment.