New Client Form

First Pet
Select One:*
- Dog
- Cat
Pet Information
Name Breed Microchip (Yes or No) Date of Birth Color Sex Spayed or Neutered
Date of Vaccinations
Rabies Distemper/Parvo Bordetella
Date of Vaccinations
Rabies Feline Distemper +3 Feline Leukemia
Second Pet
Select One:
- Dog
- Cat
Pet Information
Name Breed Microchip (Yes or No) Date of Birth Color Sex Spayed or Neutered
Date of Vaccinations
Rabies Distemper/Parvo Bordetella
Date of Vaccinations
Rabies Feline Distemper +3 Feline Leukemia
Third Pet
Select One:
- Dog
- Cat
Pet Information
Name Breed Microchip (Yes or No) Date of Birth Color Sex Spayed or Neutered
Date of Vaccinations
Rabies Distemper/Parvo Bordetella
Date of Vaccinations
Rabies Feline Distemper +3 Feline Leukemia

Pre-Existing Conditions (if any):
Pet #1 Conditions
Pet #2 Conditions
Pet #3 Conditions
Is your pet (#1, #2 and/or #3) currently receiving any medication (heartworm preventative, allergy medication, etc.)?
- Yes
- No
If yes, what?
Does your pet have any known drug allergies?
- Yes
- No
If yes, what?
Referred By:
ALL FEES MUST BE PAID AT TIME OF SERVICE

In the case of an emergency and /or hospitalization, a deposit may be required.

Upon request, we will provide you with a written estimate of fees before care is provided.
Type Signature

Trinity Pet Clinic

Rabies	Distemper/Parvo	Bordetella

Rabies	Feline Distemper +3	Feline Leukemia

Rabies	Distemper/Parvo	Bordetella

Rabies	Feline Distemper +3	Feline Leukemia