Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone

Which number is best to reach you at? *

Home
Cell

Can you receive text messages? *

Yes
No

Email *

Add a Co-Owner? *

Yes
No

Name

First

Last

Home Phone

Cell Phone

Previous Veterinary Clinic (Please put NA if no previous clinic) *

Previous Vet's Phone Number

How did you hear about our hospital? *

If referred by a current client, who may we thank? *

If referred by other, who may we thank? *

At your appointment, will you need a treatment plan for services under $500? We provide exceptional care of your pets, but we don’t provide the cheapest. Treatment plans are not given over the phone beyond the office visit charge, as a treatment plan will depend on what you and the doctor decide is the best plan. *

Yes
No

What do you value in your relationship with your veterinary clinic? *

Pet Information

Pet's Name *

Sex *

Male
Female

Neutered/Spayed? *

Yes
No

Species & Breed *

Color *

Birthdate or Age *

Current Medications

Please upload records at the bottom of this form, if unable to upload please bring with you to your first appointment.

Diet and Environment

What food does your pet currently eat? *

Amount & Frequency? *

What made you choose this food? *

Are you happy with this food? *

Is your pet on any dietary supplements *

Yes
No

If so, what kind and what dosage? *

Does your pet consume table food? *

Yes
No

Please explain *

Is your pet primarily indoor or outdoor? *

Indoor
Outdoor

Are there any other animals in the household? *

Yes
No

Please describe *

Do you have your pet groomed or boarded outside of your home? *

Yes
No

If so, how often? *

Do you travel outside of Washington with your pet? *

Yes
No

If so, where? *

Past History

Has your pet had any prior illnesses, accidents, or surgeries *

Yes
No
Unknown

Please explain.

Is your pet aggressive or fearful around strangers? *

Yes
No
Unknown

Please explain. *

Is your pet on heartworm, flea/tick preventatives? *

Yes
No

How frequently? *

Year-Round
Seasonally

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications? *

Yes
No
Unknown

If yes, please list: *

Has your pet ever had a reaction to any vaccines? *

Yes
No

If yes, please list and explain: *

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. *

I have read and agree.

Do we have your permission to share your pet’s image and story on our social media, website, and other forms of related media? *

Yes
No

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Please upload any medical files for your pet.

Administration Standards

To allow for ample time for all patients and surgical procedures, Latah Creek Animal Hospital operates primarily by appointment. We request all our clients be on time for scheduled appointments and procedures. If you are 15 minutes late to your appointment you may be asked to reschedule your appointment. We do take Emergencies; however, these services may be subject to a higher fee schedule. For your convenience, we offer limited same-day appointments for urgent care sick patients they fill up fast, so we recommend calling first thing in the morning.

For your protection, and that of others, pets should be properly restrained by a leash or carrier upon arrival. If your pet requires special accommodations, please give us a call when you arrive so we can assist you and your pet.

As a new client, you agree to pay an appointment reservation fee in the amount of the exam fee. This holds your appointment time and is applied to your visit. This fee is refundable as long as you give us at least a 24 hour notice of canceling or rescheduling so that we can have time to offer that appointment time to another client. If you have a family emergency, please call us as soon as possible to discuss rescheduling. If you have a surgical procedure scheduled, we require a 72 hour notice of canceling or rescheduling.

We accept cash, debit, or all credit cards. We also offer Care Credit or Scratch Pay financing to help make care accessible to all our patients.

We would be more than happy to fill your prescription or food orders for you to pick up here at the clinic. Please call ahead or use our website to process refills. Please allow 24-48 hours for prescription refills, special order or controlled substances may require longer. We do not authorize outside pharmacy requests by phone, we can fax them on your behalf or you may pick up a written prescription and take it to a human pharmacy.

When we discuss finances together at your appointment, we would like to have the conversation about financial hardships or difficulties at that time. We know that this conversation can be difficult and want to do what we can to get your pet the care they need within your budget. A deposit of the low end of treatment plan will be required before patients are admitted, so it is important to decide if we need an alternate plan before proceeding. *

I have read and agree

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18. *

I have read and agree

Emergency Contact *

First

Last

Emergency Contact Phone *

Date *

If you have multiple pets to add, please fill out our new pet form for each individual pet.

New Clients

Thank you for choosing Latah Creek Animal Hospital

Pet Information

Diet and Environment

Past History

Administration Standards

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