New Canine Form

SHERIDAN ANIMAL HOSPITAL
2288 Sheridan Drive • Buffalo, New York 14223
Telephone (716) 833-2255 • Fax (716) 833-8525

Date*

Pet's Name*

Owner's Name*

What breed is your dog?

Sex
MaleFemale

Color

Birth-date or approx. age:

Where did you obtain your dog?

How long have you had your dog?

Is your dog Microchipped?
YesNo

If yes, what is the microchip number?

What kind of dog food do you feed?
WetDryBoth

How much & how often? (ex. 1 cup, 2x a day)

What kind of treats do you feed?

How many & how often? (ex. 2 treats in the morning and 2 treats before bed)

Is your dog’s housing primarily:
Indooror Outdoor?

Do you have any other pets at home?

What activities does your dog (or do you plan for your dog) to participate in? (Check all that apply).
Walks in the neighborhoodObedience schoolBoarding kennelHuntingDog showsObedience/agility trialsCamping/HikingGroomingBreedingWalks on bike pathShopping at pet storesPlay at dog parksWorking (please describe)

Describe (if applicable):

Has your dog ever had any serious illness in the past? Please explain.

Is your dog currently on any medication or supplements?
YesNo

If yes, please list the drug, strength and dosing directions:

Is your dog up to date with vaccinations?
YesNo

List vaccines and when due if known.

Are there any specific health or behavioral questions you would like to discuss at your visit?