We look forward to seeing you at your pet’s upcoming visit.


To streamline your pet’s appointment, we want to ask you a few questions about his or her health. ┬áPlease fill out the information below and then press submit. It shouldn’t take more than a minute or two to complete. Thank you for your cooperation. ┬áThis helps us manage our busy caseload and to provide medical care to all of the many pets that need our help.


Is this your first visit to Animal Medical of New City?
Is this a scheduled follow up appointment for a problem we have seen your pet for within the past month?

Pet Owner and Pet Name



We only use your email to help us locate medical records and to send you your pet's diagnostic results.
What is your preferred method of communication?
Though we have your phone on file, please list it again here to assist us with finding all of your pet's medical records.
Do all of your pets receive year round flea, tick, and heartworm prevention?
Which of the following parasite preventatives do you administer? Select as many as are appropriate.
If you have a cat, does he or she go outside?

Medical History

Please use the buttons below to tell us more about how your pet is behaving and feeling. At the end of this section, you'll be able to explain your answers in more detail.
How is your pet's appetite?
What have you been feeding your pet? Check all that apply.
Has your pet had any vomiting recently?
Has your pet had any diarrhea recently?
Choose the closest description that fits your pet's stool consistency
Have you noticed any blood or mucus in the stool
Has your pet had prior episodes of diarrhea?
Has your pet been sneezing, coughing, or had difficulty breathing?
Have you noticed a change in thirst or urination?
Have you noticed any lumps or bumps or changes in ones that we have already identified?
Have you removed any fleas or ticks from your pets recently?

Dermatology History

Does your pet itch, lick, chew, or bite themselves excessively and appear uncomfortable?
What part(s) of your pet's body seem to be bothered most? Select all that apply
On a scale of 1-5 with 5 being the worst how would you grade your pet's level of itchiness and discomfort
Does your pet itch intermittently or constantly?
Are other pets or family members in the household experiencing skin issues?
Use this field to describe any of your above answers or to give us more information on your pet's health

Follow up Medical History

Please grade your pets response to the prescribed treatment on a scale of 1-5 with 5 being the most improved and 1 being the least