Today's Date *

Title

Mr.
Mrs.
Dr.
Ms.

Name *

First

Last

Email *

(We will use your email address to send reminders, lab results, and relevant clinic information)

Cell Phone

Home Phone

Work Phone

Other Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Co-Owner

First

Last

Co-Owner's Phone

Co-Owner's Email

In order to prevent any interruption in your pet’s care, we ask that you call your previous veterinary office to obtain a copy of your pet’s records. Please email full medical and vaccine records to [email protected] at least 24 hours prior to your appointment. Not having records prior may result in a delay at your appointment time.

How did you hear about us? *

Terms of Service

PAYMENT IS DUE IN FULL and is required at the time services are rendered. We do not offer any form of billing. For your convenience, we accept the following forms of payment: cash, Visa, Discover, Mastercard, American Express, and Care Credit. We do not accept personal checks. For all estimates given for larger procedures or drop off appointments, a deposit of half of the high end of the estimate(s) is expected prior to your departure of your animal(s) *

I have read and I agree.

We are so happy that you decided to choose us for your pet's care! We strive to provide thorough veterinary care to all our furry patients. We pride ourselves in our commitment to the health and happiness of animals as well as our staff members. Please note clinic policy states that no verbal, emotional or physical abuse will be tolerated toward our staff members. This includes, yelling, cursing, threats, and any violent physical contact. We reserve the right to end our professional relationship if this policy is breached. *

I have read and I agree.

All of the information I have provided here is true to the best of my knowledge. I, the undersigned, being of sound mind, have read, accept, and understand the Terms of Service. I also state that I am at least 18 years of age. *

Clear Signature

Please sign above.

Social Media Release Consent

Do you give us permission to use your pet's photo on our social media pages? *

I would love to see pictures of my furry friend on your social media sites!
I respectfully decline posting pictures of my furry friend on your social media sites.

Patient Information

Pet's Name *

Nickname

Estimated Age *

Birthday *

Species

Feline (cat)
Canine (dog)

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Markings *

May we scan your pet for a microchip? *

Yes
No

Does your pet have allergies that you are aware of? *

Yes
No

If yes, what allergies does your pet have? *

Has your pet ever had a reaction to vaccines or medication? *

Yes
No

If yes, what vaccination(s) or medication(s) did your pet react to? *

Can your pet have peanut butter as a treat in the clinic? *

Yes
No

Current Medications your pet is on (please list – includes heartworm and flea/tick products):

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another pet to add?

Yes
No

Pet's Name *

Pet's Nickname

Estimated Age *

Birthday *

Species *

Feline (Cat)
Canine (dog)

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Markings *

May we scan your pet for a microchip? *

Yes
No

Does your pet have allergies that you are aware of? *

Yes
No

If yes, what allergies does your pet have? *

Has your pet ever had a reaction to vaccines or medication? *

Yes
No

If yes, what vaccination(s) or medication(s) did your pet react to? *

Can your pet have peanut butter as a treat in the clinic? *

Yes
No

Current Medications your pet is on (please list – includes heartworm and flea/tick products):

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

Do you have another medication to add?

Yes
No

Medication

Dose

How Often Administered

Last Dose Given

Date

Time

New Client Form

New Client Form

Terms of Service

Social Media Release Consent

Patient Information

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Have a Question?

Contact Info

Our Hours