New Patient Form

Thank you for giving North Valley Pet Hospital the opportunity to care for your best friend.

We are happy to answer any questions that you may have about your pet.

To ensure the best care possible, please take the time to fill this form out completely. Thank you!

 

Client Information

  • Name*

  • Spouse/Partner

  • Mailing Address*

  • Primary Phone*

  • Home/Cell Phone

  • Work Phone

  • Are you a seasonal resident (snowbird)

    Yes No
  • What other state do you reside in?

  • Email*

  • Is it okay to post pet pictures on Social Media?

    Yes No
  • How did you hear about North Valley Pet Hospital?*

    Newspaper Drive by Internet Search Website Past Client Phone Book Other Friend - Someone we may thank?

Pet #1 Information

  • Pet Name

    Dog Cat Other
  • Breed

  • Color

  • Birthday

    Male Neutered Female Spayed
  • Microchipped?

    Yes No
  • Heartworm Prevention?

    Yes No
  • Is there somewhere we can call for your pet's medical records?

Pet #2 Information

  • Pet Name

    Dog Cat Other
  • Breed

  • Color

  • Birthday

    Male Neutered Female Spayed
  • Microchipped?

    Yes No
  • Heartworm Prevention?

    Yes No
  • Is there somewhere we can call for your pet's medical records?

  • We will gladly provide a written estimate of service fees if you desire (please ask a Receptionist). I hereby authorize the veterinarian and/or professional staff to examine, prescribe for, and treat the above described pet(s). All professional fees are due at the time of service. To prevent the spread of infectious disease all hospitalized and boarding patients must be current on vaccinations and free from external parasites. Signing below authorizes this level of preventive care and the appropriate charges will be assessed.*
  • I Agree
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PETSimonials

North Valley Pet Hospital employs such a tremendous team that does not overlook any details. Personable, reliable, and efficient are words that describe North Valley Pet Hospital. I would not trust another establishment to take care of my fur babies.