New Pet Information Form

If you are currently a client of our practice, please complete this form for any new or additional furry, four-legged family members. (If you are a new client as well as an owner of a new pet, you need only fill out the "New Client Form")

In order to serve you better, please bring in or have prior veterinary care providers FAX (763-477-4367) or email (rockfordvet@rockfordvetclinic.com) any medical history of your pet to our clinic.

We will gladly provide a written estimate for treatment plans upon request. All professional fees are due at the time of service. We accept cash, check and major credit cards (American Express, MasterCard, Visa and Discover).

Client Information
Name*
First Last
Date*
MM
DD
YYYY
Home Phone*
Cell Phone
Business Phone
Email*
Spouse or Co-Owner
Spouse/Co-Owner Phone
Patient Information
Pet's Name*
Pet Species*
If other, please specify*
Age/Birth Date*
Breed*
Color*
Sex*
- Male
- Female
Is your pet neutered/spayed?*
- Yes
- No
Does your pet have any prior or current medical condition(s) that we should be aware of? If yes, please specify.
Does your pet have any allergies/reactions to medications or vaccines? If yes, please specify.
Is your pet currently on medications? If yes, please specify.
Describe your pet's diet (type/quantity).
Do you prefer to have reminders sent via:*
- Mail
- Email only
- Both

New Pet Information Form

Client Information

Patient Information

Connect with us and one of our team members

will be happy to assist you.