New Client Registration

New Client Registration

House Call Pet Service with Dr. Jennifer Barrington
Welcome and thank you for choosing House Call Pet Service for your veterinary care.

Please have any previous veterinary records handy while filling out this form. If you have any questions, please contact me.

Thank you,
Dr. Jennifer Barrington

House Call Pet Service, LLC

2397 NW Kings Blvd #120
Corvallis, OR 97330

housecallpetservice.com

Owner Information
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Employer*
Spouse/Co-owner Information
Spouse/Co-owner Name

First NameLast Name
Spouse/Co-owner Email Address
example@example.com
Spouse/Co-owner Phone Number

Area CodePhone Number
Spouse/Co-owner Employer

Pet Information
Pet Name*
Species/Breed*
Color*
Date of Birth *

MonthDayYear
Estimate if you are not sure.
Microchip Number
Sex*

FemaleMale
Spayed or neutered?*

YesNoDon't know
If Not Spayed, Last Heat
Weight
Date of Last Vaccinations

MonthDayYear
Date
Allergies to Medication*
Other Medical History*
Do you have another pet?*

YesNo

Second Pet Information
Pet Name*
Species/Breed*
Color*
Date of Birth *

MonthDayYear
Estimate if you are not sure.
Microchip Number
Sex*

FemaleMale
Spayed or neutered?*

YesNoDon't know
If Not Spayed, Last Heat
Weight
Date of Last Vaccinations

MonthDayYear
Date
Allergies to Medication*
Other Medical History*
Do you have another pet?*

YesNo

Third Pet Information
Pet Name*
Species/Breed*
Color*
Date of Birth *

MonthDayYear
Estimate if you are not sure.
Microchip Number
Sex*

FemaleMale
Spayed or neutered?*

YesNoDon't know
If Not Spayed, Last Heat
Weight
Date of Last Vaccinations

MonthDayYear
Date
Allergies to Medication*
Other Medical History*

Previous Veterinarian
Do you have a previous veterinarian?

YesNo
Name of Previous Veterinarian*
Name of Previous Clinic*
May I request records for all your pets from your previous veterinarian? *

YesNo

Comments/Questions & Submit
If you have any comments or questions, please add them here.
Thank you!
Again, thank you for choosing House Call Pet Service for your veterinary care.

See you soon,
Dr. Jennifer Barrington
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