Intake Forms

(Click the links below to download printable forms in PDF or MS Word format)

	Client / Patient Intake Form	This is for new clients who are meeting with one of our doctors for the first time. The information you provide will facilitate your pet’s inclusion into our computer system and ensure timely communication with your general veterinarian.
	Drop-off Intake Form	This is for clients who are dropping their pet off for the day and who do not have a specific appointment with a doctor. This information will facilitate your pet’s timely care, communication with you about your pet, as well as seeing to your pharmacy needs.
	Chemotherapy Patient Update Form	This is for clients who are dropping their pet off for chemotherapy. This information will be used to make important decisions about your pet's treatment. Inclusion of contact information and pharmacy needs will allow us to discharge your pet, pills in paw, as soon as they are ready.
	Dermatology History	This is for clients bringing their pet to the dermatologist for the first time. This extensive history is critical to the diagnosis and management of skin diseases. Please take the time to fill out this history form in detail.
	Emergency Patient Intake Form	Fill this form out to aid our emergency staff in making decisions in regard to your pet's medical treatment.
	Holistic Patient Intake Form (Ella Wood MS, Dipl. Oriental Medicine)	This is for clients bringing their pets to see Ella Woods for the first time. This form includes questions regarding the health history of your pet as well as a more in-depth look into your pet's life and interactions in their home environment. While filling this out, please keep in mind that Ella is looking for more nuanced/subtle information than may not in the regular medical records. Please complete this form prior to your intial holistic consult.
BEHAVIOR CONSULTATION FORMS
	Behavior Consultation Form (Dr. Leslie Cooper)	Please complete this questionnaire before your appointment with Dr. Cooper, and either e-mail it to her at llcooper@dcn.davis.ca.us or fax it to (415) 401-9201 in advance of the appointment.
	Feline General Behavior	Fill out this form prior to your behavioral consult if this consult is not related to a problem involving the litter box.
	Canine Aggression Toward Humans	Fill out this form prior to your behavioral consult if your dog's primary behavioral problem is that he or she is aggressive toward some humans.
	Canine General Behavior	Fill out this form prior to your behavioral consult if your dog's primary behavioral problem does not involve aggression toward humans or separation anxiety.
	Canine Separation Anxiety	Fill out this form prior to your behavioral consult if your dog's primary behavioral problem might be separation anxiety.