Cedar Creek Veterinary New Client Form

At Cedar Creek Veterinary Clinic, our goal is to enhance the human-animal bond by providing the highest quality of care for your pets. Our devoted and compassionate team of veterinarians and support staff are committed to making you and your pets feel comfortable and welcome at every visit.

OWNER NAME *

First Name Last Name

SECONDARY OWNER/CONTACT

First Name Last Name

PRIMARY CELL PHONE # *

SECONDARY PHONE *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

EMAIL ADDRESS *

example@example.com

NAME OF PET *

TYPE OF PET *

DOG CAT

SEX *

MALE INTACT MALE NEUTERED FEMALE INTACT FEMALE SPAYED

BREED *

COLOR *

BIRTH DATE OR AGE *

MEDICAL DIAGNOSIS/CONDITIONS *

CURRENT MEDICATIONS *

WILL YOU BE PROVIDING PREVIOUS RECORDS? *

YES NO ( PLEASE PROVIDE PREVIOUS VETERINARY PRACTICE NAME BELOW)

PREVIOUS VETERINARY PRACTICE NAME *

YOU CAN PROVIDE RECORDS HERE IF YOU WOULD LIKE

Browse Files

DOES YOUR PET HAVE ANY STRESS OR ANXIETY WHEN COMING IN? PLEASE PROVIDE MORE INFORMATION *

FOR ADDITIONAL PETS: PUT NAME, SEX, BREED, COLOR AND AGE

New client appointments may extend 2-4 weeks out when making your appointment based on availabilty. This form is not intended or used for emergencey purposes. Should an emergency arise please contact the Northeast Indiana Veterinary Emergency Specialty Hospital (NIVES) (260) 426-1062, open 24/7.

At Cedar Creek Veterinary Clinic, our goal is to enhance the human-animal bond by providing the highest quality of care for your pets. Our devoted and compassionate team of veterinarians and support staff are committed to making you and your pets feel comfortable and welcome at every visit.

PET HEALTH HISTORY