Skip to content
360-577-1093
Online Pharmacy
hours
location
Riverside
Animal Hospital
COVID-19 Updates
Today: 8:00 am - 5:00 pm
Open Hours
360-577-1093
Phone Number
506 Allen Street
Kelso, WA, 98626
Home
Our Practice
Services
Contact Us
Pet Corner
New Patient Form
Pet Health Records
Request a Refill
Online Pharmacy
Payment Options
Request an Appointment
today:2020-08-03
Pet & Client Information Form
Fill out the fields below prior to your pet’s upcoming appointment
Your First Name
*
Middle Initial
Your Last Name
*
Mailing Address
*
Physical Street Address
City
State
Zip
Primary Phone Number
*
Cell Phone Number
Employer
Work Phone Number
Driver's License or State ID
*
State
*
Email
*
Preferred Contact Method
*
Email
Text
Call
Alternate Contact
Alternate Contact Cell
Do we have permission to text you about appointments, updates on your pet, etc.?
*
Yes
No
Prior/Secondary Veterinary Clinic
Emergency Contact
*
Emergency Contact Phone
*
Your Pet's Name
*
Pet's Species
Canine
Feline
Rabbit
Guinea Pig
Ferret
Other
Sex
*
Male
Female
Fixed
*
Neutered
Spayed
No
Pet's Age
List Previous Conditions
Pet's Insurance Provider & Policy Number (if applicable)
Please ask for specifics when discussing treatment recommendations with your pet’s doctor as charges are based on the type of care needed for your pet. While our clinic does not offer in-house payment plans, we do accept all other forms of payment including Scratch Pay and Care Credit. Payment is due at the time of service. I agree to this by signing below.
Signature & Date
*
