New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you.

New Client

Name: (required)
First Name (required)
Last Name (required)
Spouse/Co-Owner: (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
,
County (required)

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months (required)

Species of Pet (required) :
Color: (required)

Breed: (required)

Sex: (required)
Male
Female


Neutered/Spayed? (required)
Neutered
Spayed


Are your pets vaccines current? (required)
Yes
No


Medical records at another veterinary Practice? (required)
Yes
No


Name of Former Veterinary Practice. (required)

May we request a transfer of records? (required)
Yes
No


Would you like us to call you for your appointment?
Reasons or conditions that prompted your visit? (required)

Special requests or conditions? (required)

Please list any additional pets here (required)

Do we have your permission to transfer your pet's medical records FROM our hospital? (required)
Yes
No


Do we have your permission to post pictures of your pet publicly? (required)
Yes
No


Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Windy Hill Veterinary Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Windy Hill Veterinary Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and - (required)
I Agree
I Disagree


Referred by: (required)

Name
First Name
Last Name

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