FVC - New Client Form

Appointment Information
Thank you for giving us the opportunity to care for your pet. To help us provide the best possible care today and in the future, please take a moment to share some important information with us.

We understand that plans can sometimes change. If you do need to adjust or cancel your appointment, we would greatly appreciate it if you could let us know more than 24 hours in advance so we can offer that time to another pet in need.
Do you already have an appointment booked with us?*

YesNo
If no, what day and time would like to request?

MonthDayYearHourMinutesAM/PM Option
Please be aware that this is an appointment request only. Our team at Fernwood Veterinary Clinic will be in touch soon to officially confirm your booking.
Owners Information
Full Name*

First NameLast Name
Preferred Pronouns
Primary Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
E-mail*
Address*

Street Address

Apt, Suite, Bldg. (Optional)

CityState / Province

Postal / Zip CodeCountry
Spouse's Information
Spouse's Name

First NameLast Name
Preferred Pronouns
Spouse's Phone Number

Area CodePhone Number
Spouse's E-mail
May we send you reminders, notices, and information by email?
Pet's Information
Please fill out all of the following information about your pet.
Pet's Name*
(The star of the show!)
Species*
Breed*
Color*
Birth Date

MonthDayYear
(If you aren't sure, an approximate date or year is perfectly fine.)
Birth Date*

MonthDayYear
Sex*

FemaleMale
Fixed*

YesNoUnsure
Last Vaccinations
Previous Clinic
Medical Issues
Pet Insurance*

YesNo
If yes, which company
Policy #
Microchip/Tattoo #
Have your pets traveled outside of the area?*

YesNo
If yes, where have they traveled?
Do you have any other pets?
Should be Empty:

Appointment Information

Owners Information

Spouse's Information

Pet's Information