New Client Form

New Client Form

7328 Better Way SE B120 Snoqualmie, WA 98065 Phone:(425) 292-0288
Welcome! Thank you for choosing Salish Veterinary Hospital for your pet care needs. So that we may provide your pet with the best comprehensive and personalized care, please complete the following form so we can get you scheduled for your first appointment.
Owner(s) Name*

Owner(s) First NameLast Name
Spouse/Significant Other Name
Street Address*
City*
State*
Zip*
Phone*
Cell
Email*
example@example.com
Alternate Phone
PET INFORMATION
Pet's name*
Species*

DogCatOther (rodent or rabbit)
Breed*
Color*
Birthday or Age of Pet*
Sex of Pet*

Intact MaleIntact FemaleNeutered MaleSpayed Female
Where did you obtain this pet?*

BreederPet ShopShelterRescue OrganizationFriend/RelativeOther
MEDICAL RECORDS:
Previous Veterinarian (if applicable)
Previous Vet Phone
Previous Vet Email
example@example.com
Could your pet's records be under a different name? If so, please detail:
*if you have physical copies of your pets previous records, please email them to us prior to your appointment to frontdesk@salishvet.com*

Please note: We need your pet's medical records prior to your appointment to provide optimal recommendations. To expedite this process we will request records from your previous provider.
Additional Pet Information (if applicable):
Pet's Name
Species

DogCatOther (rodent or rabbit)
Breed
Color
Birthdate or Age
Sex

Intact MaleIntact FemaleNeutered MaleSpayed Female
Where did you obtain this pet

BreederPet ShopShelterRescue OrganizationOther
Medical Records-2nd Pet
Previous Veterinarian Office
Previous Vet Phone
Please enter a valid phone number.
Previous Vet Email
Could your pet's records be under a different name?
If so please detail
Additional Pet Information (if applicable):
Pet's Name
Species

DogCatOther (rodent or rabbit)
Breed
Color
Birthdate or Age
Sex

Intact MaleIntact FemaleNeutered MaleSpayed Female
Where did you obtain this pet

BreederPet ShopShelterRescue OrganizationOther
Medical Records-3rd Pet
Previous Veterinarian Office
Previous Vet Phone
Please enter a valid phone number.
Previous Vet Email
Could your pet's records be under a different name?
If so, please detail
PLEASE NOTE: After we receive your completed form please allow 24-48 hours for one of our staff members to reach out to you to get you and your pet scheduled. Please note that at this time our current wait time for a new client exam is around 5-7 days. We require 24-hour advance notice for cancellations. Thank you!

I hereby authorize the veterinarians and staff to obtain medical records, examine, prescribe for, and/or treat the above-described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that any and all charges will be paid for at the time when services are rendered and that a deposit may be required for any hospitalization, treatment, and or surgery. We accept the following forms of payment: Cash, Debit, Visa/MC, Amex, Discover, and CareCredit.

SALISH VETERINARY HOSPITAL DOES NOT OFFER BILLING. ALL PAYMENTS ARE DUE IN FULL AT THE TIME WHEN SERVICES ARE RENDERED. PLEASE INFORM EITHER A VETERINARIAN OR TECHNICIAN IF YOU REQUIRE AN ESTIMATE BEFORE SERVICES ARE PERFORMED.
Signature of Owner*

Clear
Date*

MonthDayYear
Date
Thank you for choosing Salish Veterinary Hospitall
Should be Empty:

New Client Form

PET INFORMATION

MEDICAL RECORDS:

Additional Pet Information (if applicable):

Medical Records-2nd Pet

Additional Pet Information (if applicable):

Medical Records-3rd Pet