New Patient Registration Form

Do you live in Washington State?*

YesNo

New Patient Registration Form

For emergencies, please contact your nearest emergency hospital. Do not fill out this form.
Pet Owner Details:
How did you hear about us?*
Please Specify
Have you or your pet received acupuncture treatment?*

YesNo
Primary Owner's Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address (this is where your pet's appointment will take place):*

Street Address

Street Address Line 2

CityState

Zip Code
Pet Patient Details:
What is your pet's name?*
Is your pet spayed or neutered?
What is your pet's approximate age? *
Please answer in years
What is your pet's breed?*
What is your pet's approximate weight?*
Please answer in pounds
What services are you interested in for your pet? (you can select multiple)*

Acupuncture consultNutritional consult and recipesHerbal medicineRehabilitation for pre-surgery, post-surgery, injuryTherapeutic laser and/or In-home Laser Rental ProgramQuality of life assessment, Palliative care consultWellness and Fitness (I have no specific concerns about my pet!)Other
Preferred Appointment Time
Appointments are scheduled based on your location:

Duvall, Monroe, Snohomish - Mon. 9AM - 7PM
Sammanish, Snoqualmie, Carnation - Wed. - 9AM - 7PM
Bothell, Woodinville, Redmond - Thur., Fri. - 10AM - 7 PM
Does above day of the week and time work for where you live?
If your preference is outside of our typical schedule, what is your preferred day and time?
Please Select Your Preferred Appointment Time:

Between 9:00 AM and 3:00 PMBetween 3:00 PM and 7:00 PMNo preferenceNon of the above time work for me
Are you booking for Initial Consultation or Follow-Up Consultation?
How soon would you like to book this appointment? (If your pet is experiencing an emergency, please contact an emergency veterinary clinic immediately)
Consent for Communication

Please let us know how you prefer to be contacted for appointment scheduling, confirmation, and reminders. No advertisement will be sent without prior consent.
Select at least one (or all) that apply

Phone - I give permission to be contacted via phone for appointment reminders, updates, or inquiries related to my pet's careText Message - I give permission to be contacted via text message for appointment reminders, updates, or inquiries related to my pet's careEmail - I give permission to be contacted via email for appointment reminders, updates, or inquiries related to my pet's care.
Is there anything else you want to tell us or ask before booking appointment?*

0/200

SORRY!

Patter Paws Integrative is only able to provide services to pets living in Washington State.
Should be Empty:

New Patient Registration Form

Preferred Appointment Time

Consent for Communication