VetMED Veterinary Hospital

202 N. Walnut St.
Bay City, MI 48706

(989)684-4877

vetmedhospital.com

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 for your cooperation in letting us assist you.

Please keep in mind that payment is due at time services are rendered.

**If your appointment is skin related i.e. itching, fleas, lesions etc. Please fill out a Skin History Form to expedite your appointment.**

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months, or Date of Birth

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pet's vaccines current?
Do you have pet's medical records?
Medical records at another veterinary practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


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

Special requests or conditions?

Please list any additional pets here

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 VetMED Veterinary Hospital and that charges are due and payable at the time of services rendered.
I have read this statement and -
I Agree
I Disagree



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