Client Information Sheet in Hillsboro, OR

Primary Owner

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

Email

Joint Owner

First Last

Home Phone

Work Phone

Cell Phone

Email

How did you hear about us? Whom may we thank?

Method of payment today

Payment is required at the time of service. For your convenience, we accept Visa, MasterCard, American Express, cash or check (with valid driver's license).

Please check one

Cash
Check
Debit/Credit

Does your pet have Pet Insurance?

Yes
No

Which company?

If not, are you interested in learning about Pet Insurance?

Yes
No

Pet Information

Name

Age/Birthday

Breed

Color

Sex

Male
Female

Spayed/Neutered?

Yes
No

Does your pet have previous veterinary medical records?

Yes
No

If yes, where?

Does your cat have allergies?

Yes
No
N/A

Has your cat ever had a reaction to vaccines or medications?

Yes
No
N/A

if yes, what?

List any medications your pet is currently taking:

List any behavior problems we need to be aware of

List any foods and treats you give your pet:

Digital Signature

Date

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Method of payment today

Pet Information

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