Owner's Name *

First

Last

Email *

Phone *

I consent to receive SMS text messages from Bristol County Veterinary Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Pet Information

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Pet's Name *

Species

Breed

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Sex

Male
Female

Color

Spayed/Neutered?

Yes
No

Age/DOB

When and where did you get your puppy? *

Pet Insurance

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Insurance Co.

Policy No.

*If your pet is not covered by pet insurance, please note that we here at Bristol County Veterinary Hospital highly recommend it. Please ask us about the different plans out there and what we consider to be the top three.

Media Release

After an explanation of its intended use, I authorize the staff at Bristol County Veterinary Hospital to release pictures and videos of my pet and pet's care to use with the following media entities: *

Bristol County Veterinary Hospital Social Media Accounts (Facebook, Instagram)
Bristol County Veterinary Hospital Website
Veterinary Information Network, Journal of AVMA, Other Veterinary Journals
Decline All

I am interested in educating the public about my pet, my pet's condition and medical care and authorize this veterinary practice to use such materials for this purpose. I agree not to file any claim for revenue or lawsuit for damages against this veterinary practice with respect to the release of this information. *

I have read and agree to the terms
I have read and decline

Additional Information

Have you noticed any issues/problems with your new puppy?

Yes
No

If yes, please describe

What type of training are you doing for your puppy?

Have you started flea/tick and heartworm prevention?

Yes
No

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Do you have any other pets?

Yes
No

Are they up to date on vaccines, heartworm and flea/tick prevention?

Yes
No

BCVH vaccination & testing recommendations for dogs:

Core vaccines that every dog should receive-

Rabies (per state law)
Distemper (DHPP/DAPPv)

Non-core vaccines that we strongly recommend in our area-

Leptospirosis (annual)
Lyme (annual)

Non-core vaccines based on lifestyle-

Bordetella (kennel cough) for dogs who visit groomers, kennels, day care, or dog parks

Semi-annual & annual testing-

Heartworm/tick borne disease testing: started at 7 months of age and then annual testing for life or if symptomatic for heartworm disease/tick borne diseases including Lyme, Anaplasma, and Ehrlichia.
Bloodwork & urinalysis testing:

I have read and understand BCVH vaccination & testing recommendations.

I have read and understand BCVH vaccination & testing recommendations.

Will your pet go to the following: Boarding, grooming, dog parks, daycare?

Yes
No

What are you currently feeding and what is the amount you're giving?

Medical Records

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new puppy exam

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Media Release

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