New Client Form
Please answer the following questions to the best of your knowledge. This form must be completed prior to becoming a client with us. **A member of our team will contact you if we are able to schedule your pet(s). Please allow 3-5 days to be contacted** WE REQUIRE A PREPAYMENT OF THE EXAM ($78) THIS MUST BE PAID BEFORE APPOINTMENT IS MADE. CARD OVER THE PHONE PREFERED OR CASH BROUGHT TO THE OFFICE.
Full Name
*
First Name
Last Name
Spouse Name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list the following information about all of your pet(s) that we will be seeing: Name, age/date of birth, sex and if fixed, & color
*
List all medications and supplements that your pet is currently taking
Primary reason for your pet(s) visit. If any concerns, please state how long the issue has been going on
*
Are there any prior illnesses or injuries that we need to be aware of?
*
Where does your pet spend most of their time?
*
Indoors
Outdoors
Is your pet current on their Rabies vaccination?
*
Yes
No
Name of previous veterinarian and their phone#
*
Who were you referred by?
*
Please upload any records that you may have here:
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