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
Home Address*
City*
State*
Zip*
Phone*
Cell
Email*
example@example.com
Alternate Phone
Alternate Email
example@example.com
PET INFORMATION
Pet's name*
Species*

DogCat
Breed*
Color*
Birthday or Age of Pet*
Sex of Pet*

MaleFemale
Spayed or Neutered?*

YesNo
Where did you obtain this pet?*

BreederPet ShopShelterRescue OrganizationFriend/RelativeOther
NEW PETS TO OUR HOSPITAL:
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 will not schedule your appointment until we have all pertinent previous medical records on file. To expedite this process you can request records from your previous provider and email them to us.
New Puppy or Kitten Information
Have they received any of their vaccines?

YesNo
If so, when and where were they given?
IMPORTANT: Please bring any vaccination history you may have to your first appointment
Medical History
Is your pet up to date on vaccines?*

YesNo
If yes, when and where were they given?
Is your pet on any current medications or supplements?*

YesNo
If so, please detail the medications and/or supplements
Does your pet have any known allergies to any medications?*

YesNo
If yes, please detail:
What brand of food do you feed your pet? *
Canned or dry food? *
How much do you feed per day? *
Is it grain free food?*

YesNo
Does your pet have any known food allergies?*

YesNo
If so, please detail
Does your pet have any significant medical history or recurrent problems? *
What is your pet's surgical history?*
What is your reason for scheduling your pets appointment with us?*
Please check any symptoms that you have noticed about your pet:*

VomitingDiarrheaLoss of AppetiteDepressedBad Breath oftenLethargyIncreased UrineIncreased ThirstLimpingWeight LossSneezingGaggingCoughingRunny EyesHair lossScootingSmelly earsEye IrritationScratchingLumpsPain or straining when urinating or defecatingNone
If pain or straining while urinating or defecating, please elaborate
Does your pet have any aggression issues with other animals?*

YesNo
If so, please detail
Does your pet have any temperament or behavioral issues that we should be aware of?*

YesNo
Is there anything else you think we should know about your pet?*
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 14 days. We require 24-hour advance notice for cancellations. Thank you!

I hereby authorize the veterinarians and staff to 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

NEW PETS TO OUR HOSPITAL:

New Puppy or Kitten Information

Medical History