Client Name *

First

Last

Pet's Name *

Date *

Primary Phone *

I consent to receive SMS text messages from San Antonio Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

**I authorize my pet to have annual bloodwork performed: (We offer 3 different panels that range from $159-249 and include a heartworm test for dogs and cats.)

Bloodwork *

Yes
No

I authorize my pet to have an intestinal parasite screening $38.00 (fecal test): *

Yes
No

I authorize my pet to have a heartworm test $42.00 (Canine only): *

Yes
No

I would like my pet to have a nail trim ($25.00 feline and $30.00 canine) *

Yes
No

I would like my pet to have an anal gland expression (Canine only) $38.00 *

Yes
No

Risk factors (FOR CANINES ONLY): These can help us evaluate your pet’s potential risk for leptospirosis, canine influenza, lyme and other tick-borne diseases.

(if you check yes to any of the following, the veterinary technicians will go over the recommended vaccines with you)

• Has contact with other pets*

Yes
No

• Has the opportunity to drink from ponds, puddles, or standing water

Yes
No

• Has access to livestock or wildlife+

Yes
No

• Goes to the dog park, boarding facility or grooming*

Yes
No

• Travels outside of the State of FL**

Yes
No

• Has access/goes in heavily wooded areas**

Yes
No

Risk factors (FOR FELINES ONLY): These can help us evaluate your pet’s potential risk for feline leukemia or FIV.

• Is strictly indoors only

Yes
No

• Is mainly indoors only but has access to screened in lanai

Yes
No

• Is both indoors and outdoors with no restrictions

Yes
No

• Is outdoors only

Yes
No

Preventions and medications:

• Is your pet on monthly flea/heartworm/tick prevention?

Yes
No

Brand:

Date last given:

Signature *

Clear Signature

Date *

Wellness Exam Form

Wellness Exam Form

Book An Appointment

Online Pharmacy

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Address

Contact

Hours

We proudly serve the pets of San Antonio, FL and the Surrounding Areas:

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