New Client Form

Save time during your next appointment! Complete your required forms online before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name(Required)

First Last

Owner/Financial Responsible Party Primary Phone(Required)

Please Select Phone Number Type(Required)

Email(Required)

Co-Owner's Name (if applicable)

First Last

Co-Owner's Phone

Please Select Phone Number Type

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who else is authorized to make decisions about your pet's healthcare?(Required)

First Last

Phone

Please Select Phone Number Type

How did you find out about our hospital? If you were referred by someone, who should we thank?(Required)

Pet's Name(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Age/Date of Birth(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Does your pet have a microchip identification?(Required)

Yes

No

Where can we call for previous medical records?

General Information

Where did you get your pet?(Required)

When?

Has your pet ever lived outside the area?

Yes

No

When?(Required)

Does your pet travel outside the area?

Yes

No

When?(Required)

Does your pet go outdoors at all?(Required)

Yes

No

List any pets living in the household

Medical Information

Any known previous injuries, surgeries, or medical?(Required)

Any known allergies (including allergic reactions to medication/vaccination)?(Required)

Is your pet currently on any medications or supplements?(Required)

No

Yes

Medication Name(s)?(Required)

Has your dog been tested for Heartworm Disease?(Required)

No

Yes

When?(Required)

Is your dog on Heartworm Preventative?(Required)

No

Yes

Has your cat been tested for Feline Leukemia Virus?(Required)

No

Yes

When?(Required)

Why type of food does your pet eat?(Required)

Food Type(Required)

Canned

Dry

How many cups/day?(Required)

Add another pet?(Required)

Yes

No

Pet's Name(Required)

Breed(Required)

Species (dog, cat, etc.)(Required)

Age/Date of Birth(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Does your pet have a microchip identification?(Required)

Yes

No

Where can we call for previous medical records?(Required)

General Information

Where did you get your pet?(Required)

When?(Required)

Has your pet ever lived outside the area?(Required)

Yes

No

Where?(Required)

Does your pet travel outside the area?(Required)

Yes

No

Where?(Required)

Does your pet go outdoors at all?(Required)

Yes

No

Medical Information

Any known previous injuries, surgeries, or medical?(Required)

Any known allergies (including allergic reactions to medication/vaccination)?(Required)

Is your pet currently on any medications or supplements?(Required)

Yes

No

Medication Name(s)?(Required)

Has your dog been tested for Heartworm Disease?(Required)

Yes

No

When?(Required)

Is your dog on Heartworm Preventative?(Required)

Yes

No

Has your cat been tested for Feline Leukemia Virus?(Required)

Yes

No

When?(Required)

Why type of food does your pet eat?(Required)

Food Type(Required)

Canned

Dry

How many cups/day?(Required)

Payment Consent(Required)

I have read and accept the financial policy.

Payment is due in full at the time services are performed. We accept cash, Visa, MasterCard, Discover, American Express, CareCredit, and Scratch Pay payments. We neither extend credit nor bill for services. If being admitted into the hospital, we will begin the care of your pet once you have signed the client consent & estimate forms. If this is your first visit with us, we will require a deposit that is equal to the examination fee at the time of scheduling. This deposit will be used toward your visit.

Payment Policy(Required)

I have read and accept the policy.

If you need to cancel or reschedule your appointment, we respectfully request at least 1 hour's notice prior to the scheduled appointment. Any cancellation or reschedule made less than one hour prior to your visit will result in forfeiting your deposit. Missed scheduled appointments will also result in forfeiting the deposit. Arriving 15 minutes or later to the scheduled start time is considered a "missed appointment". Rescheduling after forfeiting the deposit will require a second deposit equal to the exam fee.

New Client Form

New Client Form

General Information

Medical Information

General Information

Medical Information

Ready to Visit

Schedule An Appointment Today!

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Contact Information

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