New Client Information

New Client Information
Today's Date

MonthDayYear
Date
Name

First NameLast Name
Spouse's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Other Phone

Area CodePhone Number
Texting Capabilities Yes/No
Drivers Lic. Number (If writing a check)
Email
example@example.com
ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED!
Please indicate your preferred form of payment
How did you hear about our clinic?
Personal Referral (Whom may we thank?)

First NameLast Name
Patient Information
If you already have an appointment scheduled for your pet, what date is is set for?

MonthDayYear
Date
Name of Pet
Breed
Date of Birth
Color/Description
Sex
Microchip #
Do you have any more pets to provide information for?
Name of Pet
Breed
Date of Birth
Color/Description
Sex
Microchip #
Previous Vet Name and Phone Number
Previous Illnesses or Surgeries
Current Medications and/or Special Diets
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Paw Plan Information
Outside Pharmacy Policy

To provide the best possible care for your pets, we do not process prescription approval requests from outside pharmacies. If you prefer to use an outside pharmacy, we’re happy to help! Upon request, we can provide a written prescription during your visit or have it ready for pickup at our clinic.* This policy helps us: 1. Ensure the highest quality of care for your pets. 2. Reduce the administrative burden on our team. 3. Allow our staff to focus more on you and your pets’ needs. We truly appreciate your understanding and trust. If you have any questions or need assistance, our team is here to help. *Unless otherwise required by applicable law.
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New Client Information

Patient Information

Outside Pharmacy Policy