New Client Registration Form

Hello and welcome to Rainier Veterinary Hospital, where we are always happy to welcome new clients and patients to our full-service veterinary practice in Seattle. We are centrally located and have been providing King County with affordable care since 1933.

We look forward to seeing your pet for wellness/healthy pet visits as well as for new/acute illnesses and chronic/pre-existing diseases, including those that have been previously diagnosed and/or treated. Although Rainier Veterinary Hospital is not an emergency facility, we are happy to see your pet for more urgent matters in order to assess whether referral to a critical care facility is necessary.

Our veterinarians and staff are devoted to staying on top of the latest diagnostics, treatments, and wellness programs to maintain your pet’s optimal health. Let’s work together to keep your pet happy and healthy!

Please use the form below to get started. Contact us if you have any questions or to schedule an immediate appointment. We look forward to meeting you and your pets!

New Client Registration Form

TELL US ABOUT YOU

First Name *

Last Name *

Spouse/Significant Other/Family

Address *

Address

Address

Address

City

City

State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State/Province

Zip/Postal

Zip/Postal

Email Address *

Home Phone *

Work Phone

Cell Phone *

Preferred Method of Contact *

Email

Cell Phone

Home Phone

Work Phone

Other (please explain)Other (please explain)

Who Can We Thank for Referring You?

Preferred Appointment Date *

Preferred Appointment Time *

Early Morning (8–10 am)

Late Morning (10:30 am–Noon)

Early Afternoon (12:30–3 pm)

Late Afternoon (3:30–6 pm)

A few notes about appointments:

• This is not an automatic process. Once we receive your request, we will contact you to confirm a date and time that is as close to your request as possible.
• This form should only be used for requesting appointments that will take place at least 14 full business days after the time of the submission of this form.
• If your appointment has not been confirmed within 48 hours, please feel free to contact the practice by phone to confirm: 206.324.4144.

TELL US ABOUT YOUR PETS

Pet's Name *

Species *

Canine

Feline

Sex *

Male

Female

Spayed / Neutered *

Yes

No

Microchip *

No

Yes, Number:Yes, Number:

Breed *

Color *

Pet Age

Allergies *

No

Yes, please explainYes, please explain

Chronic Conditions *

No

Yes, please explainYes, please explain

Medications/Supplements *

No

Yes, please explainYes, please explain

Special Diet *

No

Yes, please explainYes, please explain

If you have another pet to add, please click the "Add" button below.

Add Remove

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PROVIDED

In admitting my pet for diagnostics, treatment, or surgery, I authorize the veterinarians of Rainier Veterinary Hospital and their support staff to administer such treatment and/or perform such diagnostic or surgical treatment as deemed necessary. It is understood that I may request an estimate of charges for any services. No guarantee or assurance can be made as to the results that may be obtained. Furthermore, I realize that these charges may exceed a given estimate if complications arise. I understand that I will be contacted prior to treatment, if possible, should complications arise. I assume financial responsibility for all charges incurred for services provided and understand that full payment is required upon request. *

Yes, I understand and agree to the payment terms.

Please type your name to confirm your understanding and agreement with our payment terms. *

Today's Date *

If you are human, leave this field blank.

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