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Home New Clients Client Information Form

Client Information Form

This form is intended to ensure your contact information is up to date for our records. We ask this to be completed any time a new pet is scheduled, for both new and existing clients.

Owner's Information
Primary Contact Name*

First

Last
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone*
Type
Email*
Communication Preference*
- Text
- Email
- Phone Call
Please let us know your preferred form of communication for any time we need to reach out regarding your pet’s health, diagnostic testing or results.
What are your pronouns?*
- She/Her
- He/Him
- They/Them
- Other
- Prefer not to say
Secondary Contact Information
Secondary Contact Name*
Secondary Contact Phone Number*
Type
Communication Preference*
- Text
- Email
- Phone Call
Please let us know your preferred form of communication for any time we need to reach out regarding your pet’s health, diagnostic testing or results.
What are your pronouns?*
- She/Her
- He/Him
- They/Them
- Other
- Prefer not to say
PET INFORMATION
Pet's Name*
Species*
- Cat
- Dog
Breed*
Color*
Date of Birth (Approximate)*
Sex*
- Intact Male
- Neutered Male
- Intact Female
- Spayed Female
- Unknown
PET QUESTIONNAIRE
Which of the following best describes your pet?*
- Family Member
- Child’s Pet
- Backyard Pet
Where does your pet spend their time?*
- Indoor only
- Outdoor only
- Both
Has your pet had any serious illnesses or surgeries?*
Does your pet have any allergies to vaccinations or medications?*
Is your pet on any special diets or medications?*
Would you like to be present during the treatment of your pet?*
- Yes
- No
Have you had your pet genetically tested?*
- Yes, breed only
- Yes, breed and health results
- No
If you have genetic results, please upload them here
Drop files here or

Max. file size: 50 MB.
Do you use a Groomer or Boarding Kennel?*
- Yes
- No
Do you travel, hike, camp or hunt with your pet?*
- Yes
- No
Are you currently using any type of flea preventive?*
- Yes
- No
Does your pet have a microchip?*
- Yes
- No
It would be helpful to the treatment of your pet if we could obtain his/her previous medical records. May we contact your previous Veterinarian to obtain them?*
- Yes
- No
If you have a copy of your pet's previous records, please upload them here
Drop files here or

Max. file size: 50 MB.
If you do not have access to your pet’s prior records, we are happy to contact your prior vet’s office on your behalf to request records.
Do you consent to this communication?*
- Yes
- No
If no, please contact the prior vet at least 48 hours before your first appointment with us and request they send all of your pet’s medical records and vaccine history for your pet to our email at [email protected].
If yes, please provide the following information.
1. Name of your pet’s prior vet location(s)
2. Phone number of prior vet location(s)
3. Your specific pet’s name, owner’s first and last name, as well as owner’s phone number if it is different than what is provided in this form. (For example, if you have changed your pet’s name since adoption or if prior owners handled vet visits and the office files would be under a different name than your own.)
4. If all the owner contact information and pet’s name is the same at the prior vet as it is provided in this form, please note this by entering “Same Information” below.
Write your response for above here*
The health status of your human family may effect the medical recommendations for your pet's preventative healthcare. Is anyone in your household immune compromised (Cancer, Diabetes, Hepatitis or HIV positive)?*
- Yes
- No
Do you consent to photos of your pet being utilized in hospital promotions and on Social Media?*
- Yes
- No

Get in touch

(215) 721-6989

78 Souderton Hatfield Pike
Souderton, PA 18964

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Contact Us for an Appointment

Online Pharmacy

78 Souderton Hatfield Pike
Souderton, PA 18964

HOME
ABOUT
CLIENT FORMS
SERVICES
URGENT CARE
ONLINE PHARMACY
FEAR FREE
CONTACT
- Send Us A Message
- PetDesk Mobile App

Make an Appointment

Business Hours

Mon

9:00am - 7:00pm

Tues

9:00am - 7:00pm

Wed

9:00am - 7:00pm

Thu

9:00am - 7:00pm

Fri

9:00am - 5:00pm

Sat

9:00am - 4:00pm

Sun

Closed

*Saturday Urgent Care 12pm - 4pm

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