Intake Form

To expedite check-in at your first visit, please fill out and submit this New Client Form in advance of your appointment.

New Client

Primary Pet Parent

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

What's the best way to reach you?

Home

Cell

Work

I have call blocking turned on.

Your Email

We communicate via email when vaccines are due or when lab work is back. We also give updates when your pet is hospitalized.

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referred By

How did you hear about us?

Alternate Contact Person

In the event we cannot reach you, who can we call on behalf of your pet?

First Name

Last Name

Your Pets

Please list each of your pets along with their name, sex, color, breed, date of birth, and whether or not they are neutered.

Existing Records

Please provide the name and phone number of your previous veterinarian so we can call and request your pet's health records.

Illness / Allergies / Surgeries

Please list each of your pets by name along with any pertinent medical history. If none, please state NONE.

Vaccinations & Medical Treatments

List date and location each pet received the following vaccines or treatments: distemper, rabies, leukemia, lyme, bordetella, heartworm test, feline leukemia / AIDS test

I consent to having my pet's photo taken.

We sometimes use in-office photos on facebook or in brochures.

Yes

Update Form

To update your existing client info, please fill out and submit this Update Form ahead of your next appointment.

Existing Client

Primary Pet Parent

First Name

Last Name

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

What's the best way to reach you?

Home

Cell

Work

I have call blocking turned on.

Your Email

We communicate via email when vaccines are due or when lab work is back. We also give updates when your pet is hospitalized.

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Pets

Please list each of your pets along with their name, sex, color, breed, date of birth, and whether or not they are neutered.

Intake Form

New Client

Thank you for submitting your new client intake form! We'll be in touch if we have any follow up questions. We look forward to meeting you and your pet!

Update Form

Existing Client

Thank you for submitting your new client intake form! We'll be in touch if we have any follow up questions. We look forward to meeting you and your pet!