New Client Form

"*" indicates required fields

Welcome to Raymore Veterinary Center! We are honored that you have chosen us to help you take care of your pet’s health needs. Please take a moment to fill out this form.

Client Information

First Name*

Last Name*

Address*

Street Address

City

State

ZIP Code

Phone Number*

Date of Birth*

MM slash DD slash YYYY

Email*

Spouse First Name

Spouse Last Name

Spouse Phone Number

How did you become aware of our practice?

Pet Information

Name*

Species*

Cat

Dog

Breed*

Color*

Birth Date or Approximate Age*

Sex*

Male

Female

Spayed/Neutered*

Yes

Name of Previous Veterinary Clinic

Phone Number of Previous Veterinary Clinic

Is there anything we should know about your pet's medical history like special diets, medications, or allergies?

Additional Information

We take pictures of pets for our files and occasionally to post to social media. May we post your pet's pictures to social media? No personal information will be disclosed without your explicit permission, only pictures and your pet's name.*

Yes

What are your preferred methods of communication for pet health reminders?*

Text

Post Card

Please provide any additional health records you may have for your pet(s). They can be attached below or brought in to your first appointment.

Additional Health Records

Max. file size: 50 MB.

All fees are due at the time of service. For your convenience we accept Checks, Visa, MasterCard, Discover, American Express and Care Credit. By signing below, I acknowledge that I understand and agree that in the event of default, I am liable for all cost of collection. Including collection fees, reasonable attorney feeds, court costs, and all other costs related to the collection of this debt.

Signature*