ST. CLOUD VETERINARY CENTER
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New Client Form
WELCOME TO OUR PRACTICE!
Thank you for giving us the opportunity to care for your pet. We'll be happy to answer any questions you have about your pet's health. To ensure the best care possible, please fill in this form
completely.
*
Indicates required field
Does your pet have an appointment?
*
Yes
No
Appointment date & time (previously scheduled appointments ONLY)
*
Owner Information:
Owner's Name:
*
First
Last
Address:
*
Line 1
Line 2
City
State
Zip Code
Country
Email:
*
How did you hear about our clinic?
*
Client/Word of Mouth
Internet Search
Advertisment
Sign
Spouse's Name:
*
First
Last
Cell Number *Primary:
*
Home Number *Secondary:
*
Do you authorize text and email notifications?
*
Yes
No
Pet's Information:
Pet's Name:
*
First
Last
Birthdate (if known):
*
Approximate Age:
*
Choose One:
*
Dog
Cat
Bird
Reptile
Small Mammal (ie: rabbit, hamster)
Other
Breed:
*
Color:
*
Sex:
*
Male
Female
Unknown
Neutered:
*
Yes
No
Unknown
Date of last exam (if known):
*
Date of last vaccines and type (if known):
*
Known allergies:
*
What food(s) do you feed?
*
Is your pet on heartworm prevention?
*
Yes
No
Is your pet on flea/tick prevention?
*
Yes
No
Which one?
*
Which one?
*
CATS ONLY:
Leukemia/AIDS tested:
*
Yes
No
Unknown
Vaccinated for FELV/FIV:
*
Yes
No
Unknown
My cat lives:
*
Indoor ONLY
Outdoor ONLY
Indoor & Outdoor
Date vaccinated (if known):
*
Method of Payment:
CASH, CHECK, CREDIT CARD, CARE CREDIT.
I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of
RELEASE
and that a
DEPOSIT
may be required for hospitalization or treatment.
Owner or Responsible Party:
*
First
Last
Date:
*
Submit
Home
Services
Meet the Doctor
Meet Your Care Team
New Client Form
Frequently Asked Questions
Contact Us
Client Resources