New Client Registration Form

Thank you for the opportunity to care for your pet. Please take a moment to complete this form before your first visit.

New Client Registration Form

CLIENT REGISTRATION

First Name
Last Name
City
State/Province
Zip/Postal
:

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 2 full business days after the time of the submission of this form.
  • On the last Wednesday of every month, we are closed from Noon to 3 pm for a staff meeting, and appointments are not available at this time.
  • If your appointment has not been confirmed within 24 hours, please feel free to contact the practice by phone to confirm: (206) 324-4144.

PATIENT REGISTRATION

MEDICAL HISTORY

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

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