VetMED Veterinary Hospital

202 N. Walnut St.
Bay City, MI 48706


New Client Check In

If you would like to make an appointment, you can assist us to expedite your check-in by submitting this form.

Thank you for your cooperation in letting us assist you.

Please keep in mind that payment is due at time services are rendered.

**If your appointment is skin related i.e. itching, fleas, lesions etc. Please fill out a Skin History Form to expedite your appointment.**

New Client

Your Name (required)
First Name (required)
Last Name (required)
First Name
Last Name
Relationship to Owner (Spouse,mother, etc.)

Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
Phone TypePhone Number
Co-Owner Phone
Phone TypePhone Number
E-Mail Address :
How did you hear about our clinic? (required) :
Pet's Name (required)

Type of Pet (required) :
Breed (For dogs if they are a mixed breed please say mix. For cats domestic longhair,shorthair, or mediumhair can be used if you do not know the specific breed) (required)

Age: Years, Months, or Date of Birth (if you do not know please give an approximate age) (required)

Color of Pet: (required)

Sex: (required)


Neutered/Spayed: (required)

Not Fixed

Are your pet's vaccines current?
Do you have pet's medical records?
Medical records at another veterinary practice?


Name of Former Veterinary Practice.

May we request a transfer of records?


Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

How would you like us to reach you to set up an appointment? (required) :

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