Exclusively Cats Veterinary Hospital

6650 Highland Road, Suite 116
Waterford, MI 48327

(248)666-5287

www.ecats.vet



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.


If you submit this form to us, we will contact you within one business day. If this is an emergency during normal business hours, please call us at 248-666-5287. If this is an after-hours emergency, please contact a veterinary emergency hospital.


Thank you for your co-operation 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)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
Alternative contact
First Name
Last Name
Alternate Contact E-Mail Address :
Alternate Contact Phone
Phone TypePhone Number
Pet's Name (required)

Age: Years, Months

Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your cats vaccines current?
Do you have pets medical records?
Medical records at another veterinary practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Exclusively Cats Veterinary Hospital, and that charges are due and payable at the time of service, unless other arrangements are made in advance.
I have read this statement and -
I Agree
I Disagree


How did you hear about us?


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