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New Client Form


Email Address*



Alternate Contact

How did you hear about us?

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If personal referral, who may we thank?

This is our new client information form. 

Please fill it out prior to your first appointment (or come 10 minutes early for the paper version).  

Please fill out the new patient (pet) form below for each new pet.

**If you are an established client with a new pet, simply skip to the second set of questions for your new pet! But, feel free to use this form, if we need to update any of your information!**

New Patient (Pet) Form

Please fill out this form for each new pet.

Pet's Name*



Select an option

Birthdate or estimate*

Are you planning to spay or neuter your pet, if not already done?

Select an option

If not planning to spay or neuter, are you planning to breed your pet?

Select an option

How long have you owned this pet? Where did you get him/her?

Is your pet microchipped?

Select an option

How much time is spent outside?

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What brand of food does your pet eat? Canned, dry, or pouch? Table scraps?

How do you view your pet, in terms of overall health and wellness?*

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Previous veterinary clinic?

Any treatments for illnesses or health issues in the past? Please explain.

Is your pet currently taking heartworm preventative?

Select an option

Is your pet currently on flea control?

Select an option

Please list any other medications your pet may be taking (including supplements).

Please list any allergies (foods, drugs) that your pet may have.

Any additional information we might need on you or your pet?

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