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Home Our Hospital Forms New Client Form

New Client Form

We thank you for choosing our health care team. Please complete the following information to help us provide your pet with quality care.
Owner information
Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Email*
Alternate Email
Phone #1*
Phone #2
Phone #3
Preferred method of contact*
- Text
- Email
- Phone
- Mail
Name of husband/wife

First

Last
Referred by

First

Last
Pet information
Pet's name*
Pet type*
- Dog
- Cat
Breed*
Color*
Age or date of birth*
Pet's gender*
- Male
- Female
Is your pet spayed or neutered?*
- Yes
- No
How long have you owned this pet?*
Where does this pet sleep?*
Date of last vaccine and/or test given
Last veterinarian who provided services for your pet
Are there any previous medical problems or allergies of which we should be aware?*
- Yes
- No
Please explain*
Is your pet currently on any medications?*
- Yes
- No
What medications is your pet taking?*
What brand of pet food do you currently feed?
Do you have any other pets?*
- Yes
- No
How many?*
Due to the nature of the services rendered in this office, full payment is required when services are rendered. A substantial deposit is required on hospitalized patients when charges of $100 (one hundred dollars) or more are incurred. Please indicate below your choice of payment.
Form of payment
- Cash
- Personal check
- Visa/MasterCard/Discover
- Care Credit

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Home
Urgent Care
Our Hospital
Services
- View All Services
- Virtual Care
New Clients
Shop Online
Forms
Pet Portal
Contact Us

Get in touch

989-275-5003

116 Lake St,
Roscommon, MI 48653

Make an appointment

989-275-5003

116 Lake St,
Roscommon, MI 48653

Make an Appointment

Pharmacy Pet Portal

Home
Urgent Care
Our Hospital
Services
- View All Services
- Virtual Care
New Clients
Shop Online
Forms
Pet Portal
Contact Us

Business Hours

Monday

8:30am - 5:00pm

Tuesday

8:30am - 6:00pm

Wednesday

8:30am - 5:00pm

Thursday

8:30am - 6:00pm

Friday

8:30am - 5:00pm

Saturday

Closed

Sunday

Closed

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