New Client Form Before Your Pet’s Visit Please be sure to complete our New Client Form below: Please enable JavaScript in your browser to complete this form.Contact Information Owner's Name *FirstLastOwner's AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Email *Co-Owner's Name & Contact InformationCo-Owner's Name FirstLastCo-Owner's Phone Number Pet InformationPet's Name *Species *DogCatRabbitReptileOtherIf other, please specify *Breed (if known)Color *Date of Birth or Age (if known) *Gender *MaleFemaleUnknownSpayed/Neutered *YesNoHas your pet been seen at a Previous Veterinary Practice or had vaccinations previously *YesNoIf yes, please list where *Is your pet currently on any medication or supplements? *YesNoIf yes, please list medications(s) and supplement *Has your pet had any serious medical history that we should know about? *Fear Free QuestionnaireCheck any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end. * Getting in their carrier or the car Entering the veterinary hospital Other pets and/or people passing by while in reception/check-in Waiting with other people and animals in the waiting area Being approached by veterinary staff Getting on the scale for a weight Hearing the doorbell, overhead intercom, or phones ringing Sounds coming from the back areas of the practice Going into the exam room Being put up on the table for examination Having direct eye contact with the technician and/or veterinarian Loud voices during examination Having a rectal temperature takenThe use of instruments such as the stethoscope or otoscope (to look in the ears) Being taken out of the exam room for procedures None of the aboveAre there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) If so, how did your pet react?Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?Is there anything else that you can tell us about your pet that would be helpful for their visit with us?Add another pet? *YesNoPet Information Pet's Name *Species *DogCatRabbitReptileOtherIf other, please specifyBreed (if known)Color *Date of Birth or Age (if known) *Gender *MaleFemaleUnknownSpayed/Neutered *YesNoHas your pet been seen at a Previous Veterinary Practice or had vaccinations previously *YesNoIf yes, please list whereIs your pet currently on any medication or supplements? *YesNoIf yes, please list medications(s) and supplementHas your pet had any serious medical history that we should know about?Fear Free Questionnaire Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end. * Getting in their carrier or the car Entering the veterinary hospital Other pets and/or people passing by while in reception/check-in Waiting with other people and animals in the waiting area Being approached by veterinary staff Getting on the scale for a weight Hearing the doorbell, overhead intercom, or phones ringing Sounds coming from the back areas of the practice Going into the exam room Being put up on the table for examination Having direct eye contact with the technician and/or veterinarian Loud voices during examination Having a rectal temperature takenThe use of instruments such as the stethoscope or otoscope (to look in the ears) Being taken out of the exam room for procedures None of the aboveAre there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) If so, how did your pet react?Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?Is there anything else that you can tell us about your pet that would be helpful for their visit with us? Submit
