New Canine Patient Form

Name: Santa Rosa Veterinary Hospital
Address: 2002 4th St, Santa Rosa, CA, 95404, United States
Telephone: 707-544-1313
Price range: $

Please fill out the following form before your scheduled appointment with us!

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New Canine Patient Form

Thank you for choosing Santa Rosa Veterinary Hospital. Please fill out the following form as thoroughly as possible so we can get to know your pet before their appointment with us. If you are in need of immediate assistance, please contact us at 707-544-1313.

Owner's Name *

First

Last

Email *

Pet's Name *

Age *

At Santa Rosa Veterinary Hospital we believe in developing healthcare plans customized to the lifestyle of each pet. We also are concerned about protecting family members from animal-borne diseases or parasites. Please answer the following questions so that, together, we can create a health plan specific to your pet.

Where does your dog spend his/her time? *

House and fenced yard only
Leashed walks in neighborhood
Off leash
Dog Parks
“Natural areas” i.e.: Spring Lake, coast, river, camping, ranch land, etc.

Please check all that apply

Environment /Lifestyle *

Deer visit your neighborhood
Small animals (raccoon, opossums, squirrels, etc.) visit your neighborhood
Your dog drinks from puddles
Your dog sleeps with people
Your dog gets on the furniture
Your dog goes to shows or performance events
Your dog goes to a groomer
Your dog goes to a boarding facility

Please check all that apply

Other

There are children in your household
There is someone immune compromised (Aids, cancer treatment, organ transplant, etc.) in your household

Please check all that apply

Has your pet ever acted aggressive towards people? *

Under what circumstances? *

Ready for a visit?

We proudly serve the pets of Santa Rosa, Cotati, Rohnert Park, Sebastopol, Petaluma, and beyond. We look forward to seeing you and your pet—request an appointment today! And with our new app, you may request appointments 24/7, receive automatic reminders, save notes, photos, and much more.

Book Appointment Download App

Have a question?

Get in touch! Complete our online form, and a member of our team will be in touch with you shortly.

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Where to Find Us

2002 4th St
Santa Rosa, CA 95404

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Our Hours

Mon–Fri: 8am – 12pm & 1pm – 5:30pm
(Closed during lunch time)
Sat–Sun: Closed

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Get in Touch

707-544-1313
707-544-0417 (fax)
[email protected]

Name *

First

Last

Email *

Phone

How can we help you? *

Name