New Patient Form

Thank you for choosing Scappoose Veterinary Hospital to care for your pet. Completing this form prior to your appointment will greatly assist us in adding you and your pet to our system.

Patient Information:

Pet's Name

Species

Age / DOB

Color

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Reason for your pet's visit: