Intake Form - Duluth | BluePearl Pet Hospital

Appointment Deposit Policy

A $50.00 booking fee is required to book a new client appointment. This $50.00 will be applied to your bill at the time of service. Please note that your booking fee is non-refundable and will be forfeited for any of the following reasons:
– Cancellation of appointment
– No Call / No Show for the appointment
– Rescheduling of appointment within 24 hours of the scheduled date
If you choose to reschedule your appointment after any of the previous circumstances, a new booking fee will be required. If you need to reschedule or cancel the day of your appointment because of an extenuating circumstance, it is at the discretion of the Practice Manager and/or the Medical Director if the deposit is refundable.

Owner Name*

Co-Owner's Name

Address*

City*

State*

ZIP code*

Primary Phone*

Alternative Phone

Email Address*

Pet's Name*

Species*

Breed*

Date of Birth (mm/dd/yyyy)*

Sex*

Female IntactMale IntactFemale SpayedMale Neutered

Does your pet have a history of fear, anxiety, aggression or biting?*

Referring Hospital*

Referring Veterinarian*

Additional Veterinarians

Reason for Visit*

Please list any health problems.*

Date*

New Client Intake Form