Veterinary Clinic Intake Form: Capture Pet Patient Details Before the Visit

A pet owner calls your clinic. The front desk scrambles to ask about the pet's breed, age, weight, vaccination history, and reason for visiting - all while the waiting room fills up. The vet walks into the exam room blind, asking the same questions the receptionist just asked. The visit takes twice as long as it should, and the owner leaves feeling like nobody was prepared.

A good intake form fixes this. It collects everything before the pet walks through the door: species, age, existing conditions, reason for the visit, and which services the owner expects. The vet reviews the chart ahead of time. The tech has the right supplies ready. The visit starts with "I see Max is here for his annual vaccines and you're concerned about a lump on his side" instead of "So what brings you in today?"

The key to a veterinary intake form is conditional logic. A wellness exam needs vaccine selection and preventative care options. A surgery visit needs procedure type and pre-op add-ons. An emergency needs triage severity and after-hours flags. One form handles all of it by showing only what's relevant to each visit type.

Pet Information

Pet details drive everything downstream. A giant breed dog costs more to sedate than a cat. A geriatric pet needs senior bloodwork. An exotic animal might require a specialist vet entirely. Start here because every section that follows depends on what kind of animal is coming in.

const petSection = form.addSubform('pet', {
    title: 'Pet Information'
});

petSection.addRow(row => {
    row.addDropdown('petType', {
        label: 'Type of Pet',
        options: [
            { id: 'dog', name: 'Dog' },
            { id: 'cat', name: 'Cat' },
            { id: 'rabbit', name: 'Rabbit' },
            { id: 'bird', name: 'Bird' },
            { id: 'reptile', name: 'Reptile' },
            { id: 'small-mammal', name: 'Small Mammal (hamster, guinea pig)' },
            { id: 'exotic', name: 'Exotic Pet' }
        ],
        isRequired: true
    });
    row.addDropdown('petSize', {
        label: 'Pet Size',
        options: [
            { id: 'small', name: 'Small (under 20 lbs)' },
            { id: 'medium', name: 'Medium (20-50 lbs)' },
            { id: 'large', name: 'Large (50-90 lbs)' },
            { id: 'giant', name: 'Giant (90+ lbs)' }
        ],
        isVisible: () => ['dog', 'cat'].includes(petType.value() ?? '')
    });
});

petSection.addRow(row => {
    row.addDropdown('petAge', {
        label: 'Pet Age',
        options: [
            { id: 'puppy-kitten', name: 'Puppy/Kitten (under 1 year)' },
            { id: 'young', name: 'Young Adult (1-3 years)' },
            { id: 'adult', name: 'Adult (3-7 years)' },
            { id: 'senior', name: 'Senior (7-10 years)' },
            { id: 'geriatric', name: 'Geriatric (10+ years)' }
        ]
    });
    row.addCheckbox('existingConditions', {
        label: 'Has Existing Health Conditions',
        tooltip: 'Chronic conditions may require additional testing'
    });
});

The size dropdown only appears for dogs and cats. Rabbits, birds, and reptiles don't use the same weight classifications, and showing irrelevant fields confuses pet owners. The "existing conditions" checkbox is a simple flag that tells the vet to pull historical records and allocate extra time. One checkbox saves five minutes of digging through charts during the visit.

Visit Type

Visit type is the branching point for the entire form. Each option unlocks a different set of follow-up questions, services, and pricing. Get this wrong and you're asking surgery patients about vaccine packages.

const visitSection = form.addSubform('visit', {
    title: 'Visit Type'
});

visitSection.addRow(row => {
    row.addRadioButton('visitType', {
        label: 'Reason for Visit',
        options: [
            { id: 'wellness', name: 'Wellness Exam' },
            { id: 'sick', name: 'Sick Visit' },
            { id: 'emergency', name: 'Emergency' },
            { id: 'surgery', name: 'Surgery' },
            { id: 'dental', name: 'Dental Care' },
            { id: 'specialist', name: 'Specialist Visit' }
        ],
        orientation: 'vertical',
        isRequired: true
    });
});

Six options cover the vast majority of veterinary visits. Wellness exams are the bread and butter - routine checkups with predictable services and pricing. Sick visits need diagnostic flexibility. Emergencies need speed and severity assessment. Surgery needs procedure selection and pre-op prep. Each path through the form feels purpose-built because it is.

Wellness Services

Wellness exams are where most clinics make their predictable revenue. Annual checkups, vaccinations, heartworm tests, and preventative medications. The form should make it easy for owners to see what's available and opt in to services they might not have considered.

const wellnessSection = form.addSubform('wellness', {
    title: 'Wellness Services',
    isVisible: () => visitType.value() === 'wellness'
});

wellnessSection.addRow(row => {
    row.addCheckbox('examFee', {
        label: 'Physical Examination',
        defaultValue: true
    });
    row.addCheckbox('vaccinations', {
        label: 'Vaccinations',
        defaultValue: true
    });
});

wellnessSection.addRow(row => {
    row.addDropdown('vaccinePackage', {
        label: 'Vaccination Package',
        options: [
            { id: 'core', name: 'Core Vaccines Only' },
            { id: 'recommended', name: 'Core + Recommended' },
            { id: 'full', name: 'Full Protection Package' }
        ],
        defaultValue: 'recommended',
        isVisible: () => vaccinations.value() === true
    });
    row.addCheckbox('heartwormTest', {
        label: 'Heartworm Test',
        defaultValue: true,
        isVisible: () => ['dog', 'cat'].includes(petType.value() ?? '')
    });
});

wellnessSection.addRow(row => {
    row.addCheckbox('fecalExam', { label: 'Fecal Examination' });
    row.addCheckbox('bloodwork', { label: 'Wellness Blood Panel' });
});

wellnessSection.addRow(row => {
    row.addCheckbox('microchip', { label: 'Microchip Implant' });
    row.addCheckbox('preventatives', {
        label: 'Flea/Tick/Heartworm Prevention (3 months)'
    });
});

The vaccine package dropdown only appears when the owner checks "Vaccinations." No point showing core vs. full protection if they don't want vaccines at all. Same logic for the heartworm test - it only shows for dogs and cats because rabbits and birds don't get heartworm. Each conditional keeps the form focused on what actually applies to this particular pet and this particular visit.

Preventative medications are an upsell opportunity that benefits both the clinic and the pet. Most owners don't think to ask about flea and tick prevention during a vaccine visit. Putting it on the form as a checkbox plants the seed. A three-month supply is easier to say yes to than a year's worth.

Surgery Details

Surgery visits need specific information upfront so the clinic can prepare properly. The procedure type determines staffing, equipment, and time allocation. Pre-op add-ons like bloodwork and IV fluids affect both cost and safety.

const surgerySection = form.addSubform('surgery', {
    title: 'Surgery Details',
    isVisible: () => visitType.value() === 'surgery'
});

surgerySection.addRow(row => {
    row.addDropdown('surgeryType', {
        label: 'Procedure',
        options: [
            { id: 'spay', name: 'Spay (Female)' },
            { id: 'neuter', name: 'Neuter (Male)' },
            { id: 'mass-removal', name: 'Mass/Tumor Removal' },
            { id: 'dental-extraction', name: 'Dental Extraction' },
            { id: 'foreign-body', name: 'Foreign Body Removal' },
            { id: 'acl', name: 'ACL/Cruciate Repair' },
            { id: 'fracture', name: 'Fracture Repair' },
            { id: 'bladder-stones', name: 'Bladder Stone Removal' }
        ],
        isRequired: true
    });
});

surgerySection.addRow(row => {
    row.addCheckbox('preSurgeryBloodwork', {
        label: 'Pre-Surgery Blood Panel',
        defaultValue: true,
        tooltip: 'Recommended for anesthesia safety'
    });
    row.addCheckbox('ivFluids', {
        label: 'IV Fluids During Surgery',
        defaultValue: true
    });
});

surgerySection.addRow(row => {
    row.addCheckbox('painMeds', {
        label: 'Pain Medication (take-home)',
        defaultValue: true
    });
    row.addCheckbox('eCollar', {
        label: 'E-Collar/Cone',
        defaultValue: true
    });
});

Pre-surgery bloodwork defaults to checked because it's a safety recommendation, not an upsell. IV fluids and pain medication are the same - they default to on because any responsible clinic would recommend them. The e-collar prevents pets from tearing at incision sites. Defaulting these to true means the owner has to actively opt out, which naturally leads to a conversation about why they're important rather than the clinic having to sell each item individually.

Emergency Visits

Emergencies are different from every other visit type. The owner is stressed, the pet may be in pain, and speed matters more than thoroughness. The form should collect just enough information to triage effectively without slowing anyone down.

const emergencySection = form.addSubform('emergency', {
    title: 'Emergency Details',
    isVisible: () => visitType.value() === 'emergency'
});

emergencySection.addRow(row => {
    row.addDropdown('emergencyType', {
        label: 'Emergency Type',
        options: [
            { id: 'trauma', name: 'Trauma/Injury' },
            { id: 'toxin', name: 'Toxin Ingestion' },
            { id: 'gi', name: 'GI Emergency (vomiting, bloat)' },
            { id: 'respiratory', name: 'Respiratory Distress' },
            { id: 'seizure', name: 'Seizures' },
            { id: 'urinary', name: 'Urinary Blockage' },
            { id: 'other', name: 'Other Emergency' }
        ],
        isRequired: true
    });
});

emergencySection.addRow(row => {
    row.addDropdown('emergencySeverity', {
        label: 'Severity Level',
        options: [
            { id: 'minor', name: 'Minor (stable, non-critical)' },
            { id: 'moderate', name: 'Moderate (needs prompt treatment)' },
            { id: 'serious', name: 'Serious (hospitalization likely)' },
            { id: 'critical', name: 'Critical (ICU/surgery needed)' }
        ]
    });
    row.addCheckbox('afterHours', {
        label: 'After-Hours/Weekend Visit',
        tooltip: 'Emergency fees are typically 30-50% higher outside business hours'
    });
});

Severity level helps the clinic prioritize. A stable, non-critical pet can wait if there's a critical case ahead of them. The after-hours checkbox is important for pricing transparency - emergency fees outside business hours are typically 30-50% higher, and owners need to know that before they arrive. Surprising someone with a $200 surcharge when their pet is already on the table destroys trust.

Emergency type helps the vet prepare before the pet arrives. Toxin ingestion needs activated charcoal on hand. A GI emergency might need X-ray or ultrasound equipment ready. Respiratory distress means oxygen support standing by. The difference between "pet is on the way" and "pet with suspected bloat is on the way" is the difference between scrambling and being ready.

Cost Estimates

Veterinary pricing is one of the most common sources of friction between clinics and pet owners. Owners feel blindsided by costs they didn't expect. Clinics feel defensive explaining prices during an emotional moment. A cost estimate in the intake form solves both problems. The owner sees a range before they walk in. The conversation shifts from "why does this cost so much" to "I see the estimate was $300-500, where do we land?"

const calculatePricing = () => {
    const visit = visitType.value();
    const size = petSize.value() || 'medium';

    const sizeMultiplier: Record<string, number> = {
        'small': 0.8, 'medium': 1.0, 'large': 1.3, 'giant': 1.6
    };
    const mult = sizeMultiplier[size] ?? 1.0;

    let low = 0, high = 0;

    if (visit === 'wellness') {
        if (examFee.value()) { low += 50; high += 100; }
        if (vaccinations.value()) {
            const pkg = vaccinePackage.value() || 'recommended';
            const costs = { 'core': [40, 80], 'recommended': [80, 150], 'full': [150, 250] };
            const [l, h] = costs[pkg] ?? [80, 150];
            low += l; high += h;
        }
        if (heartwormTest.value()) { low += 35; high += 60; }
        if (bloodwork.value()) { low += 100; high += 200; }
        if (microchip.value()) { low += 45; high += 75; }
        if (preventatives.value()) { low += 50 * mult; high += 100 * mult; }
    }

    if (visit === 'surgery') {
        const surgeryCosts = {
            'spay': [200, 500], 'neuter': [150, 400],
            'mass-removal': [300, 1500], 'acl': [2500, 5000],
            'fracture': [1500, 4000], 'foreign-body': [1500, 4000]
        };
        const [sl, sh] = surgeryCosts[surgeryType.value()] ?? [500, 2500];
        low += sl * mult; high += sh * mult;
        if (preSurgeryBloodwork.value()) { low += 80; high += 150; }
        if (ivFluids.value()) { low += 40; high += 80; }
    }

    if (visit === 'emergency') {
        const severityCosts = {
            'minor': [200, 500], 'moderate': [500, 1500],
            'serious': [1500, 4000], 'critical': [3000, 10000]
        };
        const [el, eh] = severityCosts[emergencySeverity.value()] ?? [500, 1500];
        low += el + 100; high += eh + 200;
        if (afterHours.value()) { low *= 1.3; high *= 1.5; }
    }

    return { low: Math.round(low), high: Math.round(high) };
};

resultsSection.addRow(row => {
    row.addPriceDisplay('lowEstimate', {
        label: 'Low Estimate',
        computedValue: () => calculatePricing().low,
        variant: 'default',
        prefix: 'From'
    });
    row.addPriceDisplay('highEstimate', {
        label: 'High Estimate',
        computedValue: () => calculatePricing().high,
        variant: 'default',
        prefix: 'Up to'
    });
});

Ranges protect the clinic while setting expectations. A spay for a small dog costs less than a spay for a giant breed because everything scales - anesthesia, surgical time, and recovery monitoring. The size multiplier handles this automatically. Emergency pricing factors in severity and after-hours surcharges. The owner sees a realistic window, not a single number that might be wrong.

Using PriceDisplay with "From" and "Up to" prefixes makes the range feel deliberate rather than vague. It communicates that the clinic has thought about pricing carefully and is being transparent about the variables involved.

Owner Contact Information

Collect contact details last. By this point the owner has invested time selecting services and seeing cost estimates. They're more likely to complete the form than if you'd asked for their name and email first.

const contactSection = form.addSubform('contact', {
    title: 'Owner Information'
});

contactSection.addRow(row => {
    row.addTextbox('ownerName', {
        label: 'Your Name',
        isRequired: true
    });
    row.addTextbox('petName', {
        label: 'Pet\'s Name',
        isRequired: true
    });
});

contactSection.addRow(row => {
    row.addEmail('email', {
        label: 'Email Address',
        isRequired: true
    });
    row.addTextbox('phone', {
        label: 'Phone Number',
        placeholder: '(555) 123-4567',
        isRequired: true
    });
});

Asking for the pet's name alongside the owner's name serves a practical purpose beyond the database. When the clinic calls to confirm the appointment, "Hi Sarah, we're looking forward to seeing Bella on Thursday" is warmer than "Hi, confirming your appointment." Pet owners respond to their pet's name being used. It signals that the clinic sees their animal as a patient, not a transaction.

Common Mistakes

Making the form too clinical. Pet owners aren't veterinary professionals. "Ovariohysterectomy" means nothing to most people - "Spay (Female)" does. Use plain language for every option, every label, every tooltip. If the owner has to Google a term on your form, you've lost them. Save the medical terminology for the chart.

Not handling emergencies differently. An emergency intake form should be fast and focused. Three fields maximum: what happened, how bad is it, when are you arriving. Don't ask emergency patients about vaccine packages or microchip implants. Conditional logic means emergency visits see only emergency questions. Everything else disappears.

Forgetting exotic pets. Roughly 10% of pet owners have birds, reptiles, or other exotics. If your form only has "dog" and "cat" as options, you're telling those owners you don't take their pets seriously. Include exotic options even if you refer them out - at least you're capturing the lead and directing them somewhere helpful instead of losing them entirely.

No cost transparency. Veterinary costs are the number one reason pet owners delay care. They don't know what a wellness visit costs, so they put it off. They don't know surgery pricing, so they agonize over the decision. Showing cost estimates in the intake form removes the fear of the unknown. Even a rough range like "$200-400 for a spay" is infinitely better than "we'll discuss pricing at the visit."