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We are truly honored you are considering The Welcome Waggin’ for your pet’s care.


Our team looks forward to building a thoughtful, lasting relationship with both you and your pet — whether through personalized in-home visits or care at our Veterinary Care Center.

 

Before completing this form, we kindly invite you to review our Service Area page to confirm that we currently provide in-home care in your location.

 

If you are outside our housecall zones, we may still be able to support you through appointments at our Care Center.

 

Taking a moment to review this information helps us serve you more efficiently and ensures a smooth scheduling experience.

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We look forward to meeting you soon.

New Patient Intake Form

Please complete this form before your first appointment

CLIENT CONTACT INFORMATION

Can this number receive texts?
Yes
No
Can this number receive texts?
Yes
No

Who else is authorized to make decisions about your pet’s health care?

How did you hear about us?

PET INFORMATION

Pet #1

Species:
Dog
Cat
Other
Sex:
Male
Male (neutered)
Female
Female (spayed)
Does your pet have microchip identification?
Yes
No
Would you like to add a second pet?
Yes
No

If yes, please complete the fields below:

Pet #2

Species:
Dog
Cat
Other
Sex:
Male
Male (neutered)
Female
Female (spayed)
Does your pet have microchip identification?
Yes
No
Would you like to add a third pet?
Yes
No

Pet #3

Species:
Dog
Cat
Other
Sex:
Male
Male (neutered)
Female
Female (spayed)
Does your pet have microchip identification?
Yes
No

Previous Veterinary Care

Can you help us gather updated records from your previous veterinarian?
Yes
No

Please send complete medical records including DVM notes, diagnostic imaging and reports, surgical reports, prescription history, and vaccination certificates to:

Email: service@thewelcomewaggin.com

Fax: 331-333-3058

REASON FOR VISIT

How may we best support your pet today?

If you are seeking Quality of Life assessment, hospice support, or euthanasia services, please complete our Quality of Life & End-of-Life Planning Form in addition to this intake.This allows our medical team to prepare thoughtfully for your visit.

AFTERCARE OPTIONS**** Only if END OF LIFE VISIT

Multi choice

LIFTING ASSISTANCE

If your pet is 35–90 lbs, do you have one person who can help lift your pet onto a stretcher? If over 90 lbs, do you have TWO people?
Yes
No
My pet weighs less than 35 lbs

MEMORIAL AUTHORIZATION

Do we have your authorization to post a memorial about your pet? (E.g., your pet’s first name and a photo would be the only identifiers.)
Yes
No

PET HEALTH DETAILS / ISSUE DESCRIPTION

Ready When You Are

Call: 630-699-3113

Text: 844-940-2360

service@thewelcomewaggin.com

16041 S Lincoln Hwy Plainfield, IL 60856

Mon - Fri: 9 am - 5 pm

Sat - Sun: By Appointment Only

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©2026 The Welcome Waggin'

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