New Client Form

Save time at your first appointment. Complete your new client form online before your visit.

Healdsburg Veterinary Hospital New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

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Name

First

Last

Email

Primary Phone

Secondary Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare?

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank?

Pet's Name

Species (dog, cat, etc.)

Breed

Age/Date of Birth

Sex

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification?

Yes
No
Don't Know

Previous Veterinarian

Previous Veterinarian Phone Number

Appointment Disclaimer

At the time of booking, we require all new clients to provide a credit card number to hold the appointment. If you need to cancel or reschedule, we respectfully request at least 24 hours' notice. Cancellations or rescheduling attempts made less than 24 hours before the scheduled appointment, or missed appointments, will result in a $75.48 cancellation fee.

Please type your initials

I have read and agree to the Appointment Disclaimer terms.

Date

Name

New Client Form

Healdsburg Veterinary Hospital New Client Form

Appointment Disclaimer

Ready to Visit?

Get in Touch

Address

Contact Information

Hours of Operation

Please call ahead for appointments