Please be aware that this form is ONLY used to update your/your new pets' information, and will not be received as an appointment request. If you are needing an appointment and have not spoken with a team member yet, please contact us via call/text/email during business hours.
*FOR NON EXISTING/NEW CLIENTS* Have you been directed to this page through way of communication with our clinic either by call, text, email, appointment reminder?
Yes
No (if choosing this option, please call us at (906)341-2813 prior to submitting this form)
NAME
*
First Name
Last Name
SPOUSE/CO-OWNER
First Name
Last Name
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER (HOME)
IF NO LANDLINE, PLEASE LEAVE BLANK
PHONE NUMBER (CELL)
IF NO CELL, PLEASE LEAVE BLANK
WHICH IS BEST FOR REMINDERS (CALL/TEXT)
IF NONE DESIRED, PLEASE LEAVE BLANK
YOUR DATE OF BIRTH
*
SPOUSE/CO-OWNER DATE OF BIRTH
YOUR STATE LICENSE NUMBER OR SOCIAL SECURITY NUMBER
IF NOT FILLED OUT, THIS MAY BE ASKED AT TIME OF PURCHASE OF SELECT MEDICATIONS
SPOUSE/CO-OWNER STATE LICENSE NUMBER OR SOCIAL SECURITY NUMBER
IF NOT FILLED OUT, THIS MAY BE ASKED AT TIME OF PURCHASE OF SELECT MEDICATIONS
EMAIL ADDRESS (FOR REMINDERS)
example@example.com
PLACE OF EMPLOYMENT
PLACE OF EMPLOYMENT OF SPOUSE/OTHER
ARE YOU OKAY WITH PICTURES OF YOUR PETS BEING POSTED ON SOCIAL MEDIA?
*
YES
NO
WHAT IS THE BEST WAY TO REACH YOU (EMAIL/TEXT/PHONE CALL)
*
PET'S NAME
*
SPECIES
*
DOG
CAT
OTHER
BREED
*
COLOR
*
DATE OF BIRTH
*
IF UNKNOWN, PLEASE PROVIDE APPRX AGE
SEX
*
MALE (UN-NEUTERED)
FEMALE (UN-SPAYED)
NEUTER
SPAY
PREVIOUS VET CLINIC/HOSPITAL
*
TYPE N/A IF UNKNOWN/IRRELEVANT
HAS YOUR PET BEEN TREATED FOR ANY ILLNESS IN THE PAST?
*
IF NO, TYPE "N/A"
REASON FOR TODAYS VISIT:
ADDITIONAL PETS (if applicable)
PET'S NAME
SPECIES
DOG
CAT
OTHER
BREED
COLOR
DATE OF BIRTH
IF UNKNOWN, PLEASE PROVIDE APPRX AGE
SEX
MALE (UN-NEUTERED)
FEMALE (UN-SPAYED)
NEUTER
SPAY
PREVIOUS VET CLINIC/HOSPITAL
TYPE N/A IF UNKNOWN/IRRELEVANT
HAS YOUR PET BEEN TREATED FOR ANY ILLNESS IN THE PAST?
IF NO, TYPE "N/A"
PET'S NAME
SPECIES
DOG
CAT
OTHER
BREED
COLOR
DATE OF BIRTH
IF UNKNOWN, PLEASE PROVIDE APPRX AGE
SEX
MALE (UN-NEUTERED)
FEMALE (UN-SPAYED)
NEUTER
SPAY
PREVIOUS VET CLINIC/HOSPITAL
TYPE N/A IF UNKNOWN/IRRELEVANT
HAS YOUR PET BEEN TREATED FOR ANY ILLNESS IN THE PAST?
IF NO, TYPE "N/A"
PET'S NAME
SPECIES
DOG
CAT
OTHER
BREED
COLOR
DATE OF BIRTH
IF UNKNOWN, PLEASE PROVIDE APPRX AGE
SEX
MALE (UN-NEUTERED)
FEMALE (UN-SPAYED)
NEUTER
SPAY
PREVIOUS VET CLINIC/HOSPITAL
TYPE N/A IF UNKNOWN/IRRELEVANT
HAS YOUR PET BEEN TREATED FOR ANY ILLNESS IN THE PAST?
IF NO, TYPE "N/A"
PET'S NAME
SPECIES
DOG
CAT
OTHER
BREED
COLOR
DATE OF BIRTH
IF UNKNOWN, PLEASE PROVIDE APPRX AGE
SEX
MALE (UN-NEUTERED)
FEMALE (UN-SPAYED)
NEUTER
SPAY
PREVIOUS VET CLINIC/HOSPITAL
TYPE N/A IF UNKNOWN/IRRELEVANT
HAS YOUR PET BEEN TREATED FOR ANY ILLNESS IN THE PAST?
IF NO, TYPE "N/A"
TYPE SIGNATURE
*
DATE SIGNED
*
Submit
Should be Empty: