New Patient Form

Name/Pet Advocate*

First Last

Significant Other/Other Owner:

First Last

Date*

Phone*

Alternate Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Emergency Contact Name:

First and Last Name

Emergency Contact Number:

How Did You Learn About Our Clinic?*

If recommended, by whom?

Number of Pets in Household*

Dogs

Cats

Indoor/Outdoor

Name of Pet*

Photo of pet (optional)

Max. file size: 100 MB.

Type of Pet*

Dog

Cat

Other

Breed*

Color*

Birthdate*

Select One*

Does your pet have any known vaccine reactions or allergies?

Does your pet take any medications for pre-vet visits?

Do you need medication refills at your visit?

Reason for medication refill(s)?

Photo of medication (optional)

Max. file size: 100 MB.

Name of Previous Clinic (if applicable)

Phone of previous clinic (if applicable)

Email of previous clinic (if applicable)

Name of Emergency or Specialty Facilities Your Pet Has Visited (if Applicable)

Name of Insurance (if applicable)

We tailor your vet’s visit to their personality and needs. Please tell us about your pet, their comfort level at past vet visits, and anything else that may help us make their experience positive!

Previous Medical Records

Max. file size: 100 MB.

Please List Any Vaccine History And Date(s) Of Vaccine

Please List Any Relevant Medical History

Reason For Your Upcoming Visit

Annual Wellness Exam

New Puppy, Kitten, or Adopted Pet

A Medical Condition or Emergency

A Medical Recheck, Surgery, or Diagnostic Test

Medication refill

During our annual wellness exam appointments, our veterinarian will examine your pet, answer any questions, and provide recommendations to keep your pet healthy. This is also when most of our patients receive their annual heartworm check and vaccines and stock up on preventative medications such as flea, tick, and heartworm. We recommend bringing a stool sample from your pet to test for parasites during the annual wellness visit. If you have any questions, please reach out to our team. Otherwise, we look forward to seeing you soon!

Congratulations on your new family member! During an appointment for your new pet, our veterinarian will examine them, answer questions, and discuss any current concerns and needs. Please bring any records you may have received regarding your pet’s age, health, and vaccine history to this appointment. And if you have any questions, reach out to our team. We look forward to seeing you soon!

If your pet is facing a medical condition or emergency, contact our team at (857) 277-7781 to discuss booking an emergency visit. Please also complete any details below about your pet’s condition or current symptoms. We look forward to serving you and your pet soon!

Please share any details below about your pet’s current symptoms or condition. For questions, don't hesitate to contact our team at (857) 277-7781. Otherwise, if your pet is not currently experiencing an emergency medical condition, we’ll reach out to discuss the best days and times for your pet’s recheck, surgery, or tests. We look forward to seeing you soon!

Select Any Symptoms or Problems You Have Noticed About Your Pet:

Depending on the symptoms your pet is experiencing, it may be critical that they are seen immediately. If you are concerned about your pet or believe they need emergency care, please call our team at (857) 277-7781.

When did your pet’s symptoms start?

Since your pet’s symptoms started, have they:

Improved

Worsened

Stayed the same

Has your pet experienced any changes in the following (check all that apply)?

Diet

Environment

Medicine

Pet’s Current Medications

What Preventatives Are Being Used (Flea, Tick, Heartworm)?

Describe Your Pet’s Diet (Brand of Food and Feeding Schedule)

Owner’s Signature*

Date*

Do you consent to receive reminders? If so, please select one or more methods below

Text Message

I do not wish to receive reminders about my pet.

We would love to have your pet on our Instagram and Facebook!

Please choose one of the following:

Yes, I give permission to have my pet’s photo taken and put on Metrovet’s social media.

No, I decline to give permission to have photos of my pet on Metrovet’s social media.

Does your pet have its own Instagram? Let us know, and we will follow their account!

Phone

This field is for validation purposes and should be left unchanged.

To prepare for your appointment, please complete our new patient form below.

Metrovet Clinic - New Patient Form

NAVIGATE

Contact Us

Get social

Visit Us

Subscribe to get updates