New Client form for Exclusively Cats Veterinary Hospital - Cat Doctors serving the Detroit area, including Waterford, White Lake, Clarkston, West Bloomfield, Flint, Brighton MI, northern Ohio and Windsor, Canada

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 Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

Alternative contact

First Name	Last Name

Alternate Contact E-Mail Address :

Alternate Contact Phone
Phone Type	Phone 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

How did you hear about us?

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