Name: New Ulm Regional Veterinary Center
Address: 401 20th S St, New Ulm, MN, 56073, US
Telephone: (507) 233-2500

Cat

First Name *

Last Name *

Phone Number *

Email Address *

Pet's Name *

Do you have an appointment? *

Yes

No

Date of Appointment (N/A if you do not have an appointment) *

What type of food do you feed your pet? *

What is the feeding schedule? (How much AND how often, or is it free choice?) *

Is your pet mainly indoor or outdoor? *

When is the last time you dewormed your cat? *

Flea and Tick preventive

Do you use a flea & tick preventive *

Yes

No

What brands? (Enter N/A if not applicable) *

Date last given? (Enter N/A if not applicable) *

Do you need flea & tick preventative refill? *

Yes

No

If yes, number of doses?

Does your cat use the litter box appropriately? *

Yes

No

Does your pet go to or do any of the following? *

Boarding

Grooming

Hunting

Exposure to ticks

None

Is your pet currently taking any medications? *

Yes

No

What medications is your pet on? (Enter N/A if not applicable) *

Do you have insurance for your pet? *

Yes

No

Undecided

Do you have any specific concerns?

Please list all the pets you currently own:

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Dog

First Name *

Last Name *

Phone Number *

Email Address *

Pet's Name *

Do you have an appointment? *

Yes

No

Date of appointment? (Enter N/A if not applicable) *

What type of food do you feed your pet? *

What is the feeding schedule? (How much AND how often, or is it free choice?) *

Is your pet mainly indoor or outdoor? *

Heartworm Preventative

Do you use a heartworm preventative? *

Yes

No

What brand? (Enter N/A if not applicable) *

Date last given? (Enter N/A if not applicable) *

How often? *

Seasonal

Year-round

Currently not using

Do you need a refill? *

Yes

No

If yes, number of doses

Flea and Tick preventive

Do you use a flea & tick preventive *

Yes

No

What brands? (Enter N/A if not applicable) *

Date last given? (Enter N/A if not applicable) *

Do you need a flea & tick preventative refill? *

Yes

No

If yes, number of doses

Does your pet go to or do any of the following? *

Boarding

Grooming

Dog Park

Hunting

Exposure to ticks

None

Is your pet currently taking any medications? *

Yes

No

What medications is your pet on? (Enter N/A if not applicable) *

Do you have insurance for your pet? *

Yes

No

Undecided

Do you have any specific concerns?

Please list all the pets you currently own

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Other

First Name *

Last Name *

Phone Number *

Email Address *

Pet's Name *

Type of pet? *

Do you have an appointment? *

Yes

No

Date of appointment? (Enter N/A if not applicable) *

What type of food do you feed your pet? *

What is the feeding schedule? (How much AND how often, or is it free choice?) *

Is your pet currently taking any medications? (Enter N/A if not applicable) *

Yes

No

What medications is your pet on? (Enter N/A if not applicable) *

Do you have any specific concerns?

Please list all the pets you currently own

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Wellness & Vaccination Visit Form

Wellness & Vaccination Visit

Flea and Tick preventive

Heartworm Preventative

Flea and Tick preventive

Welcoming New Ulm Animals to our Animal Hospital