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UF Health University of Florida
Small Animal Hospital College of Veterinary Medicine
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Patient History Form

*This form is to be completed by the owner after an appointment has been scheduled. This is not a referral form for referring veterinarians.

Please complete the form below and click submit.

Important Appointment Details:

  • Arrive 15 minutes before your scheduled appointment time to allow for check-in and paperwork.  If you are more than 30 minutes late,  you may be asked to reschedule.
  • Do not bathe your pet, including medicated baths, for at least 2-3 days prior to your evaluation appointment.
  • Do not feed your pet after midnight prior to your  appointment, unless your pet is diabetic.  Water may be offered up to the point of the visit.
  • Continue to give thyroid or seizure medication, antibiotics, flea/tick/heartworm prevention as directed by your vet.
  • If your pet requires medication for reducing fear and/or anxiety during clinic visits, give medication as directed by your regular vet.
  • Do not clean your pet’s ears for at least 1-2 days prior to your visit.
  • Bring pet food labels along with a list of current medications.

Owner Information

Name(Required)
Home Address(Required)

Pet's Skin Health Information

By providing us with this information ahead of your visit time, you will greatly facilitate your visit and decrease your appointment length. Thank you for allowing us to help your pet.

Patient's Dermatological History

Do these skin (and/or ear) issues occur:(Required)
How itchy is your pet? Itching can include scratching, biting, licking, chewing, nibbling, rubbing, head-shaking, scooting and over-grooming.
Please describe your pet's home environment, check off all that apply:(Required)
If your pet has a history of fear or aggression, ensure they are medicated appropriately for their dermatology evaluation. If your pet is unable to be safely handled during their exam, we may require a re-scheduled appointment. Checking YES indicates you have read and understand this statement.(Required)
Upon check-in to UF Small Animal Hospital, you and your pet will be greeted in an exam room by a 3rd or 4th year veterinary student to obtain a history and perform a brief initial examination. The student will leave the room to discuss your pet with the Dermatologist, then both will discuss their initial assessment with you, additional diagnostic recommendations and a proposed treatment plan. PLEASE NOTE: Dermatology evaluations can take between 2 to 4 hours; prepare for a longer visit. Skin and/or ear samples may be collected to as part of our diagnostics for both evaluations and recheck visits. We may ask you to leave your pet during this time to complete our assessment and provide you with a detailed treatment plan. We realize that your time is valuable and will do everything possible to address your pet's needs in a timely manner. We appreciate your understanding that UF is a teaching hospital; it requires time to instruct our clinical students while providing the best care possible for your pet. I have read and acknowledge this information.(Required)

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