VetMED Veterinary Hospital

202 N. Walnut St.
Bay City, MI 48706

(989)684-4877

www.vetmedhospital.com

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)
Co-Owner
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
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)

Male
Female


Neutered/Spayed: (required)

Neutered
Spayed
Not Fixed


Are your pet's vaccines current?
Do you have pet's medical records?
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 would you like us to reach you to set up an appointment? (required) :

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