New Client Form

Thank you for giving us the opportunity to care for your pet(s).

So that we may become better acquainted, please complete the following:
DATE

MonthDayYear
Client Information
Client Name
Spouse/Secondary
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone
Is this phone able to receive text messages?

YesNo
Spouse Phone
Please enter a valid phone number.
Is this phone able to receive text messages?

YesNo
Backup Phone
Please enter a valid phone number.
Email
example@example.com- if no email please put "null@null.com"
How did you hear about us?
If selected "other source" please type source:
Pet Information
Name
DOB/Age
Sex
Is this animal spayed or neutered?

YesNoUnknown
What Type of Animal is this pet

MammalReptileBirdOther
Species:

DogCatFerretRabbit
What species of Reptile is this animal?
What species of Bird is this animal?
What species is this animal?
Breed
For cats: Domestic Long, Short, or Medium Hair
Color/colors or pattern
How long have you owned?
Are there any special considerations we should know about for this animal?

This animal is used for showingThis animal is or will be used for breddingThis is a working animalThis is a service animalOther
Are there any prior or current illnesses/health issues regarding your pet that we should know about?
Does this pet have any prior vet/adoption records?

Yes, Adoption recordsYes, from another clinic. I will contact them to have them sent overNo
You have indicated that your pet came with vaccination records from the adoption agency/breeder. Please send images of all of the records. You can text images to our main number, (716) 592-7387. You can also email them to sgndvm459@gmail.com or fax them to (716)-592-9039. All records do need to be received, along with this form, in order to schedule your first appointment.
Which clinic(s) will the records be coming from?
Please request all applicable vaccination information. Exam notes, x-rays and blood work from the lost six months should be included in records. They can emailed to sgndvm459@gmail.com or faxed to (716)-592-9039. All records do need to be received, along with this form, in order to schedule your first appointment.
Please explain why your pet doesn't have any records so we can better help them.
Sign Below to Acknowledge: All charges must be paid in full at the time of service. A deposit may be required for any surgical treatments. We accept: Cash, Check, Visa, MasterCard, Discover, AmericanExpress, and CareCredit.

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Client Information

Pet Information