New Client

Oakwood Hills Animal Hospital

4616 Commerce Valley Road
Eau Claire, WI 54701

(715)835-0112

oakwoodhillsanimalhospital.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

New Client

Name (required)

First Name (required)	Last Name (required)

E-Mail Address :

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Primary Phone (required)
Phone Type	Phone Number (required)

Secondary Individual:

Secondary individual's Phone Number:
Phone Type	Phone Number

Secondary individual's E-Mail Address :

Pet Information

Pet's Name (required)

Age or DOB

Type of Pet (required) :

Color of Pet

Breed:

Sex: (required)

Male
Female

Neutered/Spayed

Neutered
Spayed

Are your pets vaccines current?

Yes
No
Not Sure

Do you have pets medical records?

Medical records at another veterinary Practice?

Yes
No

Name of Former Veterinary Practice

Previous vet records? Name of previous vet clinic with phone number:

May we request a transfer of records?

Yes
No

Reason for this visit:

Special requests or conditions?

Please list any additional pets here

Electronic Signature

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Oakwood Hills Animal Hospital
4616 Commerce Valley Road
Eau Claire WI 54701
(715) 835-0112


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