Medical Record

Note: This is a sample medical record that you can adapt to fit your particular situation.

Medical Record

Name of pet_________________________Breed_________________________

Color______________________ Markings______________________________

Date of birth _____________________ Approximate ___ Exact ___

Sex: ___ Male ___ Female Neutered or spayed? ___ Yes ___ No

If yes, date of surgery ___________________________

General history ________________________________________________________________

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Veterinarian’s name_______________________Phone____________________

Date of FeLV test (feline only) ___________________ Results: ___ Pos ___ Neg

Date of FIV test (feline only) ___________________ Results: ___ Pos ___ Neg

Date of heartworm test (canine only) _____________ Results: ___ Pos ___ Neg

Date of last rabies vaccination ______________ Tag #_____________________

Next rabies vaccination due ______________________

Other vaccination__________________________Date___________________

Other vaccination__________________________Date___________________

Other vaccination__________________________Date___________________

Illnesses, treatments ________________________________________________________________

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Other comments ________________________________________________________________

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