Sardis Animal Hospital - New Client Form

New Client Form

Thanks for saving paper and using our digital New Client Form!

Once you submit your completed form, someone from our office will contact you to set up an appointment. And, you won’t have to come in early to fill out any paperwork!

We appreciate you choosing Sardis Animal Hospital for your pet health care needs and we look forward to meeting you both.

Owner's Name:*

First NameLast Name

Spouse/Co-owner Name:

First NameLast Name

Address:*

Street Address

Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Area CodePhone Number

Alternate Number:*

Area CodePhone Number

Email*

example@example.com

Occupation / Employer:

Work Phone:

Area CodePhone Number

May we email you with appointment reminders, news, and pet health care resources?

YesNo

Emergency Contact:

First NameLast Name

Emergency Contact Phone Number:

Area CodePhone Number

Pet Name:*

Species*

CatDogOther

Breed

Sex:*

MaleFemale

Spayed or Neutered:*

YesNoUnsure

Colour/Markings:*

Approximate Weight:*

Date of Birth or Approximate Age:*

Does your pet have an identifying tattoo? If yes, please include details.

Has your pet been microchipped? If yes, what is its ID number?

Does your pet have a rabies tag? If so, what is the issuing organization and ID number?

Previous Veterinary Hospital:

Name of Previous Veterinarian:

May we request medical records?

YesNo

Is your pet currently on any medication? If so, what?

Does your pet have any allergies or illnesses? If so, what?

If someone referred you to us, please give us their name so we may thank them.

Should we contact you to make an appointment?*

Yes, call me to schedule an appointment.No, I already have an appointment.

If you already have an appointment, when is it scheduled for?

Date

Please use the following box to give us any other relevant information about your pet.

PET INFORMATION