Welcome New Clients! Book today and get $30 off your first exam!

New Client Form

Please fill out our new client form if you would like to join the Edmonds-Westgate Veterinary family.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Current Diet (Type/ Brand Name)

Type: Wet or dry

Microchipped?

Vaccine within last 12 months?

Upload Previous Vaccine History

Click or drag a file to this area to upload.

Primary Reason for visit? *

We will gladly prepare a written estimate if desired (please ask the doctor or receptionist). ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. We accept payment in cash along with Visa, Mastercard, American Express, Discover and Care Credit. *

I have read and accept the financial policy.

To prevent the spread of infectious diseases, hospitalized and boarding patients must be current on all vaccines and free from internal and external parasites. The signature below authorizes this level of preventative care, and the appropriate charges will be due upon discharge. *

Clear Signature

Signature of client responsible for pet

Date *

Message

New Client Form

New Client Form

Ready for a visit?

Where to Find Us

How to Reach Us

Our Hours

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