New Client Check In

If you would like to schedule an appointment and we have never seen you or your pet(s) before,  you can assist us to expedite your check in by submitting this form.  Thank you for your cooporation in letting us assist you better!

Form - New Client

Name (required)
First Name (required)
Last Name (required)
Spouse or Significant Other's Name
First Name
Last Name
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Month/Day/Year (required)

Type of Pet (required) :
Breed (required)

Sex (required)
Male
Female

Neutered/Spayed (required)
Neutered
Spayed

Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice:

May we request a transfer of records?
Yes
No

Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here:

How did you come to choose our hospital?

Would you like us to call you for your appointment?
Please Read:
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Standish Veterinary Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance.
I have read this statement and
I Agree
I Disagree


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