New Patient Form

Save time during your next appointment. Complete your new patient form online from any device before your visit.

New Patient Form

Please fill out this form as completely and accurately as possible so we can get to
know you and your pets before your visit.

You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

DOWNLOAD FORM

Thank you for giving us the opportunity to care for your pet. Please help us meet your expectations better by taking a moment to share some important information we will use to provide quality medical care for your pets today and in the future.

PLEASE TYPE IN ALL SPACES.

Client's Name *

Spouse/Other

Address *

Address Line 1

Address Line 2

City

State

Zip Code

(To insure proper identification, please type your home’s entire physical address)

Alternate/Seasonal Address

Address Line 1

Address Line 2

City

State

Zip Code

(To insure proper identification, please type your alternate address entire physical address)

Primary Phone *

Secondary Phone

Fax

Email Address *

Employer

Work Phone

Spouse/Other Employer

Work Phone

Emergency Contact *

Emergency Contact Phone Number *

We will gladly prepare a written estimate if you desire (please ask our doctor or technician). This will be important to you since ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. Any account 30 days or more past due will be assessed a monthly interest charge of 1 ½% of the unpaid balance with the minimum fee of $4.75. Additionally, you agree to reimburse us the fees of any collection agency, which may be based on a percentage at a maximum of 30% of the debt, and all costs, and expenses, including reasonable attorneys’ fees, we incur in such collection efforts. Please note, there will be a $25.00 service charge for any check returned unpaid.

To prevent the spread of infectious diseases, all hospitalized and boarded patients must be current on all vaccines and free from internal and external parasites.

Signature of Responsible Agent for Pet(s) *

Clear Signature

Date *

Name and Phone Number of all previous and/or seasonal veterinarian *

Patient Information:

Pet’s Name

Animal Species *

Sex? Spayed/neutered? *

Pet Breed and Color

Pet Date of Birth or Age *

Do you have a second pet? *

New Patient Form

New Patient Form

Patient Information:

Location

Call Us

Email

Hours