New Client Welcome Form

Welcome to Williamsburg Veterinary Hospital. This New Client Welcome Form helps our team prepare for your pet’s first visit by collecting essential details about your pet’s history and your contact information in advance.

Complete Form

New Client Welcome Form

Please complete the form below before your first appointment. If you’re unsure how to answer a question, provide your best estimate, and our team will review everything with you at check-in.

Need help? Call or email Williamsburg Veterinary Hospital, and we’ll be happy to assist

IF YOU ARE NEW TO OUR HOSPITAL, PLEASE CONTACT US BY PHONE OR EMAIL TO SET UP AN APPOINTMENT BEFORE COMPLETING THIS FORM

THANK YOU

Name *

First

Last

Preferred Pronoun:

She/Her/Hers
He/Him/His
They/Them/Their

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone *

Work Phone

Cell Phone

Email *

Co-Owner Name

First

Last

Co-Owner Home Phone

Co-Owner Cell Phone

Co-Owner Work Phone

Co-Owner Email *

Preferred phone number for CALLS:

Preferred phone number for AUTOMATED TEXT REMINDERS:

Preferred email address for AUTOMATED EMAILS: *

Alternate Contact:

First

Last

Alternate Contact Phone

Alternate Contact 2

First

Last

Alternate Contact 2 Phone

Previous Veterinary Clinic:

Pet Information

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Colour *

Sex *

Male
Female

Neutered/Spayed *

Do you have any other pets in your household to register with our hospital? *

How did you hear about us? (please check all that apply)

Do you, or anybody in your house, have any allergies to antibiotics or other medications? *

Terms and Conditions

I hereby authorize Williamsburg Veterinary Hospital (WVH) to send correspondence to the address, email and fax number provided on this form and to leave messages either with a machine or with a person at the phone number(s) provided on this form. *

I have read and agree to the above statement.

I hereby consent to my personal information and/or medical information for any of my pets (present or future) being disclosed when necessary for continuity of patient care. This includes releasing or obtaining of medical records to or from any relevant veterinary hospital(s). *

I have read and agree to the above statement.

I hereby consent to any of my present or future pets’ likeness (photo or video) being used for WVH marketing purposes including use on our website or social media page(s) or other online forum. *

I have read and consent to the above statement.
I have read and do not consent to the above statement.

I hereby consent to the veterinarian or any WVH staff member using dictation software for the purpose of accurate medical records for my pet(s). *

I have read and agree to the above statement.

Professional fees are due at the time of services rendered. For payment we accept Cash, Debit, VISA & Mastercard. We regret that we DO NOT ACCEPT CHEQUES. *

I have read and accept the financial policy.

Signature of Owner or Responsible Agent

Clear Signature

Today's Date *

Website

New Client Welcome Form

New Client Welcome Form

IF YOU ARE NEW TO OUR HOSPITAL, PLEASE CONTACT US BY PHONE OR EMAIL TO SET UP AN APPOINTMENT BEFORE COMPLETING THIS FORM

THANK YOU

Pet Information

Terms and Conditions

Schedule Your Pet’s Visit Today

Contact Williamsburg Veterinary Hospital

Location

Contact Information

Hours

After-Hours Emergencies

New Client Welcome Form

New Client Welcome Form

IF YOU ARE NEW TO OUR HOSPITAL, PLEASE CONTACT US BY PHONE OR EMAIL TO SET UP AN APPOINTMENT BEFORE COMPLETING THIS FORM

***THANK YOU***

Pet Information

Terms and Conditions

THANK YOU