Welcome To City Paws Veterinary Clinic!

Welcome To City Paws Veterinary Clinic!

Thank you for choosing City Paws! Please fill out our client/patient form before your appointment to save time and allow us to serve you and your pet even better!
CLIENT REGISTRATION FORM
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone (Phone #1)

Area CodePhone Number
Phone #2

Area CodePhone Number
Spouse's Name

First NameLast Name
Spouse Phone Number

Area CodePhone Number
How did you hear about us?

Word of MouthGoogleFacebookYelpNextdoorInstagramOther online
Who can we thank for your visit today? We offer a $25 referral bonus to you both!
Pet's Name
Species
Breed
Sex

FemaleMale
Spayed/Neutered?

YesNo
Date of Birth or Approximate Age
How long have you owned this pet?
On a normal day, what does your pet eat? Please include any treats or people food
Please upload any previous vaccine summaries, records, etc.

Browse Files

Cancelof
Do you have your patient's records/last preventative care information?

YesNo
Any chronic conditions?
Is your pet on any medications or special diet?
If your patient has a social media account we'd love to follow them! @
Any known allergies or drug sensitivities?
We love taking pictures, and often snap a few during a healthy pet visit or a stay at our hospital. May we have your permission to share these on our social media channels?
Our team frequently uses dictation/transcription software to ensure accuracy and prompt completion of your pet's medical records. Do you consent to the audio recording of your pet's exam and conversations for this purpose?

YesNo
ALL FEES ARE DUE AT THE TIMES SERVICES ARE RENDERED. WE ACCEPT CASH, CHECKS, VISA, MASTERCARD, AND DISCOVER. I agree to pay any additional charges related to the cost of collection (including but not limited to collection agency fees, reasonable attorney fees and court costs), in the event I would fail to pay my bill in full.
Signature
Date

MonthDayYear
Date
info@citypawsvet.com
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