New Patient Form

725 Wing St.
Plymouth MI, 48170
(734) 655-0012
(734) 453-4144

Monday/Tuesday/Thursday/Friday: 9:00am-6:00pm
Saturday: 8:00am—12:00pm
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Thank you for visiting our hospital. We look forward to getting to know you and your pet. Please help us to provide the best care possible for your pet by taking a moment to fill out this form.

Pet's Name *

Primary Owner's Information

Email *

Name

Address

Address Cont'd

City

State

ZIP

Home Phone

Cell Phone

Work Phone

Co-Owner's Information

Name

Cell Phone

Work Phone

Other humans in the home

Other pets in the home

Please list: name, species, male/female, spayed/neutered/intact, breed, age and color.

For cats - Indoor or outdoor?

Indoor

Outdoor

In and Out

How did you find us?

How did you hear about us?

If by referral, who can we thank?

Other

How would you prefer appointment reminders?

Phone Call

Do you prefer medications in a child-proof container?

Yes

Do you prefer estimates being presented before we administer services?

Yes

Do you or a family member have an immunocompromised health status?

Yes

Previous veterinarian's information

Has this pet has any prior illness or injury that we should know about?

Is this pet currently on any of the following?

Other

If currently using medications, please tell us the name and dosage

Is your pet spayed or neutered?

Yes

Has your pet ever had a dental prophylaxis?

Yes

Do you brush your pet's teeth at home?

Yes

Brand name or description of pet's current diet:

My pet is current on the following services

Heartworm test

Fecal parasites diagnostics

Neither at this time

Does your pet feel stressed when going to the vet?

Yes

Unsure

Are you familiar with Fear-Free methods?

Yes

Visit our office to get the latest in top-quality veterinary care along with unparalleled service.

Plymouth Veterinary Hospital, Inc.

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The content provided on this website is intended for educational purposes only. Plymouth Veterinary Hospital, Inc. does not provide veterinary medical advice via the internet. Please consult your veterinarian for the best recommendations for your pets. ©2021 Plymouth Veterinary Hospital, Inc.. Resource Articles ©2021 GeniusVets. All Rights Reserved. Veterinary websites by GeniusVets

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