Resources Please click to download one of the printable forms listed here, or fill out a Online New Client Form below Pre-Arrival Patient History Form New Client Form Pre-Anesthetic Neuter Pre-Anesthetic Dental Preparing for Anesthesia Strategic Deworming We Offer Puppy Packages We Offer Kitten Packages We Offer A Dental Package Online New Client Form New Thank you for giving us the opportunity to care for your pet. To insure the best care possible, please take the time to fill in this form completely. Please contact us at 928-522-6008 once completed in order to schedule an appointment. Thank you! Owner InformationDate MM slash DD slash YYYY Pet Owner's Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone*Home PhoneWork PhoneEmail (to sync records on Pet Desk App)* Enter Email Confirm Email Emergency Contact* First Last Emergency Contact Phone*Reason for Visit?*How did you hear about us?Number of Pets in Household* Single Dog Multiple Dogs Single Cat Multiple Cats Other (Specify Below) If Other was selected above, please specify pet. Pet InformationPet's Name* First Date of Birth* Month Day Year Select Pet Type*DogCatOther (Specify Below)If Other, Please Specify Pet's Breed* Pet's Color* Please check all applicable boxes* Male Neutered Female Spayed Vaccination History of PetPet's Current DietPlease check any symptoms or problems you have noticed about your pet: Behavioral Problems Bleeding Gums Breathing Problems Coughing Diarrhea Eye Bulging or Bloodshot Gagging Lack of Appetite Limping Loss of Balance Scooting Scratching Depression Shaking Head Sneezing Thirst &/or Urinating Increased Weakness Vomiting Other (Specify Below) Other (Please Specify) AuthorizationBy clicking "Submit" you hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. You assume responsibility for all charges incurred in the care of this animal. You also understand that these charges will be paid at the time of release and a deposit may be required for surgical treatment.You MUST check this Box to acknowledge Authorization above.* I hereby acknowledge the authorization above. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
