New Client and/or Patient Information Form

Please fill out form below and click Submit button when complete.

While we love all fur-babies, we only see dogs and cats.

Sorry, this form is not mobile-friendly at the moment!

New Client/Patient Form

Primary Client/Owner Information

Name
Name
First
Last
Preferred Pronouns (Optional)
Preferred Contact Method
Address
Address
City
State/Province
Zip/Postal
Country
Terms and conditions
Terms and Conditions

  • Payment is due at time of service and must be paid in full.
  • Payment options are only available through Scratchpay.com. (To apply, go to www.scratchpay.com and follow instructions.)
  • Hello Vet for Pets, LLC may photograph my pet and utilize those images in educational material, social media and other marketing.

Additional Owners

Name
Name
First
Last
Preferred Pronouns (Optional)
Preferred Contact Method
Additional Owner’s Address
Address
Address
City
State/Province
Zip/Postal
Country
Add Remove

Patient Information

Species
Patient is:
AGE
My Pet is Microchipped
Is your pet currently taking any of the following preventatives?
How Will You Be Scheduling Your Next Appt?

Additional Pets

Species
Patient is:
AGE
My Pet is Microchipped
Is your pet currently taking any of the following preventatives?
How Will You Be Scheduling Your Next Appt?
Add Remove

If you have medical/vaccination records, you can upload them here or send via email to supportsquad@hellovetforpets.com

Maximum upload size: 268.44MB

When you have completed filling the form, click the Submit button below.