New Client Form

We can’t wait to welcome you and your pet and care for them like they’re one of ours. Animal Clinic of Butler takes a low-stress approach to veterinary care so your best friend can stay relaxed, happy, and healthy. If you’re ready to become a new client at our vet clinic, please fill out our new client form to get started!

New Client Form

Client Information

Name

First

Last

Phone

Work Phone

Address

City

State/Province

Zip/Postal

Country

Co-Owner's Name

Co-Owner's Phone

Pet Information

Name

Species

Breed

Color

Sex

Age (if known)

Date of Birth (if known)

Neutered/Spayed

Vaccination History (Due Dates):

Rabies

DHLP Parvo

Leptospirosis

Bordetella

Fecal

Heartworm Test

FVRCP (Feline Distemper)

Feline Leukemia

Add Pet Remove Pet

Additional Information

Any previous serious illnesses or surgeries?

Any allergies to vaccinations or medications?

Is your pet on any special diets or medications?

Whom should we contact to obtain previous records for your pet?

May we contact your previous veterinarian for records?

Yes

Who is your previous veterinarian?

Please include any other names you or your pet may be listed under.

If you are human, leave this field blank.

New Client Form

Client Information

Pet Information

Vaccination History (Due Dates):

Additional Information

Get in Touch

Clinic Hours

Our Address