• Medical History Form
Hartford Animal Clinic
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Medical History Form

In order for your veterinary healthcare team to provide comprehensive care for your pet, please fill in this form prior to your visit.
  • dd/mm/yyyy
  • Due to the COVID-19 prevalence, we want to ensure your safety, and that of our team. Please answer yes/no to these questions:

    *Please note: Answering yes does NOT prohibit your pet from being seen if they are ill but allows us to put appropriate safety parameters in place for our team and doctors.
  • Owner's Name

  • Pet Information

  • Pet Health - Reason for Visit

  • Days/Weeks/Months
  • food/treats
  • poor/good/excellent
  • name/dose/last given
  • lethargic/normal/hyperactive
  • increased/normal/decreased
  • increased/normal/decreased
  • normal/abnormal
  • Date Format: MM slash DD slash YYYY

Contact

1191 Grand Avenue
Hartford, WI 53027

Phone: (262) 673-7960
Fax: (262) 673-5804
Email: [email protected]

Clinic Hours

Monday: 7:30am – 6:00pm
Tuesday: 7:30am – 6:00pm
Wednesday: 7:30am – 6:00pm
Thursday: 7:30am – 6:00pm
Friday: 7:30am – 6:00pm
Saturday: 7:30am – 12:00pm
Sunday: Closed

Emergencies

Wisconsin Veterinary Referral Center
Waukesha Location: (866) 542-3241
Grafton Location: (262) 546-0249
www.ethosvet.com

Blue Pearl
Port Washington: (262) 268-7800
Glendale: (414)-540-6710
www.blupearlvet.com

Animal Poison Control
Veterinary toxicologists available 24 hours a day
888-426-4435

© 2023 Hartford Animal Clinic.
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  • Home
  • New Clients
  • About Us
    • Team
    • Community Involvement
    • Careers
    • Promotions
    • Medical History Form
  • Services
    • Medical Services
    • Surgical Services
    • Anesthesia and Patient Monitoring
    • Preventive Services
    • Wellness and Vaccination Programs
    • Additional Services
  • Pet Health
    • Pet Health Checker
    • Pet Health Library
    • How-To Videos
    • Pet Insurance Info
    • News
  • My Pet
    • Login
    • Register
    • Book Appointment
    • Refill Request
  • Contact Us
  • Medical History Form