OFFICE HOURS

Monday through Friday
8:30 am to 5:30 pm
(252) 240-3885

After Hours
Emergency Pet Service
(252) 444-1399

Walk-ins welcome
Appointments preferred
 
The doctors and staff of PetDocks thank you for the opportunity to provide veterinary care for your pet
family member.  Please take a few moments to fill out this form as completely as possible.
Client Name
 
Pet #1
  
Pet's Name
Date of Birth or Age
Species
Dog
Cat
Other
Breed
Sex
Color/Markings
Vaccinations last given by (clinic name)
Date
Current Medications
Previous Surgeries
Allergies
Long-term Medical Problems
Pet #2
  
Pet's Name
Date of Birth or Age
Species
Dog
Cat
Other
Breed
Sex
Color/Markings
Vaccinations last given by (clinic name)
Date
Current Medications
Previous Surgeries
Allergies
Long-term Medical Problems
Pet #3
  
Pet's Name
Date of Birth or Age
Species
Dog
Cat
Other
Breed
Sex
Color/Markings
Vaccinations last given by (clinic name)
Date
Current Medications
Previous Surgeries
Allergies
Long-term Medical Problems

To help prevent the spread of infectious diseases,
ALL hospitalized and boarded animals must be current on all vaccinations.  

DUE TO STATE LAW AND INSURANCE REQUIREMENTS,
ALL DOGS AND CATS MUST BE CURRENT ON RABIES VACCINATION.  
Mailing Address
 
City
State
Zip
 
Home Phone
 
 
 
 
Work Phone
 
  
 
  
Cell Phone
 
 
 
 
E-mail
 
 
 
 
By submitting this form, you are digitally signing that:
  • you are the person identified as "client" on the first line of this form
  • you are at least 18 years of age
Please let us know if any of your contact information has changed: