New Patient Form

New Patient Form

New Patient Form

New Patient Form

New Patient Form

New Patient Form

Today's Date *

Owner’s Information

First Name *

Last Name *

Home Address*

City*

State*

Zip Code*

Mailing Address if different

City

State

Zip Code

Primary Phone*

Secondary Phone

Email *

Providing your email gives you access to your pet’s online health records, scheduling appointments and access to our on-line store

Would you like us to text appointment reminders to you? *

Do you qualify for a senior discount; 65 years of age or older? *

Alternate Contact Information

First Name *

Last Name *

Primary Phone *

Secondary Phone

Is this person allowed to make financial and/or medical decisions for your pet(s)? *

Please list any family or friends that could potentially pick up medications for your pet

How do you learn information best? *

How did you hear about our practice? * (Please choose one)

Other

Friend? (Who)

Relative? (Who)

Preferred form of communication, please circle all that apply. *

Previous Veterinarian

Pet’s Information

Name *

Dog / Cat *

Sex *

DOB *

AGE *

Breed *

Color *

Please list any medications (not flea/tick and heartworm) this patient is currently taking *

Does your pet have any known allergies *

Has this pet ever been diagnosed with a chronic illness or disease? If so please explain *

What Brand of food do you feed *

What flea/tick preventative to you use? *

Do you give year round? *

What heartworm preventative to you use? *

Do you give year round? *

What is the reason for your visit today? *

Other Pets you would like on file…

Name

Dog / Cat

SEX

DOB

AGE

Breed

Color

Name

Dog / Cat

SEX

DOB

AGE

Breed

Color

Here at the Harbor Veterinary Clinic, we love to celebrate our patients and share pictures on our website and social media pages. Do you authorize Harbor Veterinary Clinic to use any photos of your pets taken during your visit(s) with us?

Appointment

Services

Online Store

NEOK9 Solutions is owned and operated by Billy Sutton who has been working with dogs since his Army career in 2007. At the end of his career Sutton attended the Tom Rose School, LLS for Professional Dog Training in 2015.

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