Oakwood Hills Animal Hospital

4616 Commerce Valley Road
Eau Claire, WI 54701

(715)835-0112

www.oakwoodhillsanimalhospital.com

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.

Thank you for your cooporation 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)
Primary Phone (required)
Phone TypePhone Number (required)
Secondary Phone
Phone TypePhone Number
E-Mail Address :
Pet Information
Pet's Name (required)

Age or DOB

Type of Pet (required) :
Color of Pet

Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pets vaccines current?
Are your pets vaccines current?

Yes
No
Not Sure


Do you have pets medical records?
Medical records at another veterinary Practice?

Yes
No


Name of Former Veterinary Practice

Previous vet records? Name of previous vet clinic with phone number:

May we request a transfer of records?

Yes
No


Reason for this visit:

Special requests or conditions?

Please list any additional pets here

Electronic Signature


Verify the reCAPTCHA: