New Client Form

Name*

First Last
Spouse's Name

First Last
Email*
Phone
Work Phone
Cell Phone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment
Best Number to Reach You
Authorizing Signature for Release of Records *

Clear
All Fees Are Due At The Time Services Are Rendered

(We see appointments in the following order: Emergencies, Scheduled Appointments, Walk-in/Work-ins.) Please indicate choice of payment. Cash, Visa, MasterCard, Discover, Care Credit. *Pet insurance is also available. No personal checks until after the 3rd visit.
How did you find out about our hospital? If you were referred by someone, who should we thank? *
(Drove by, Yellow Pages, Previous Client, Personal Recommendation, Other)
Pet Information
Pet's Name *
Species*

CatDogOther
If Other, please explain: *
Breed*
Color*
Age/Date of Birth*
Sex*

MaleNeutered MaleFemaleSpayed Female
YOUR DOG’S VACCINATION HISTORY
Please list history for the following: RABIES, DA-CPV, BORDETELLA, LEPTO, HEARTWORM TEST, FECAL
YOUR CAT’S VACCINATION HISTORY
Please list history for the following: RABIES, CVRC (FVRCP), FELV, FELV/FIV TEST, FECAL
Our pet(s) is

Member of our familyChild’s petBackyard petInside/Outside
Any previous serious illness or surgeries?
Any allergies to vaccinations or medications?
Is your pet on any special diets or medications?
Add Another Pet?*

YesNo
Pet Information #2
Pet's Name *
Species*

CatDogOther
If Other, please explain: *
Breed*
Color*
Age/Date of Birth*
Sex*

MaleNeutered MaleFemaleSpayed Female
YOUR DOG’S VACCINATION HISTORY
Please list history for the following: RABIES, DA-CPV, BORDETELLA, LEPTO, HEARTWORM TEST, FECAL
YOUR CAT’S VACCINATION HISTORY
Please list history for the following: RABIES, CVRC (FVRCP), FELV, FELV/FIV TEST, FECAL
Our pet(s) is

Member of our familyChild’s petBackyard petInside/Outside
Any previous serious illness or surgeries?
Any allergies to vaccinations or medications?
Is your pet on any special diets or medications?
Add Another Pet?*

YesNo
Pet Information #3
Pet's Name *
Species*

CatDogOther
If Other, please explain: *
Breed*
Color*
Age/Date of Birth*
Sex*

MaleNeutered MaleFemaleSpayed Female
YOUR DOG’S VACCINATION HISTORY
Please list history for the following: RABIES, DA-CPV, BORDETELLA, LEPTO, HEARTWORM TEST, FECAL
YOUR CAT’S VACCINATION HISTORY
Please list history for the following: RABIES, CVRC (FVRCP), FELV, FELV/FIV TEST, FECAL
Our pet(s) is

Member of our familyChild’s petBackyard petInside/Outside
Any previous serious illness or surgeries?
Any allergies to vaccinations or medications?
Is your pet on any special diets or medications?
Please note: New Clients are required to place a $40 non-refundable deposit to book a first appointment. No-shows will not be refunded but you are welcome to reschedule as needed. Please call us after completing this form to place the deposit and schedule your appointment.*

I have read and understand.
We at Saunders Veterinary Services strive to give you & your pet the best personal, professional & medical attention that you deserve. It is our policy to charge an exam fee for any appointments that are not canceled 24 hours prior to the appointment time.
Please verify that you are human*
Should be Empty:

All Fees Are Due At The Time Services Are Rendered

Pet Information

Pet Information #2

Pet Information #3