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Our Hospital
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New Clients
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Contact Us

586-726-5200 Make An Appointment

Home » New Pet Patient Form

New Pet Patient Form

"*" indicates required fields

Thank you for giving us the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following.

Client Information

Client First Name*

Client Last Name*

Address*

Street Address

Address Line 2

City

State

ZIP Code

Phone*

Email*

Driver's License #

Birthdate*

MM slash DD slash YYYY

Do you want to add a co-owner to the account?*

Yes

No

Co-Owner Information

Co-Owner First Name*

Co-Owner Last Name*

Phone*

Best Time to Call*

Co-Owner's Driver's License #

Co-Owner Birthdate*

MM slash DD slash YYYY

Patient Information

Pet's Name*

Breed*

Age/DOB*

Color*

Sex*

Male

Neutered Male

Female

Spayed Female

Species*

Dog

Cat

Do you want to add a second pet?*

Yes

No

Your Dog's Medical History

Rabies Vaccine

DA2PP+CVK Vaccine

Kennel Cough Vaccine

Lyme Disease Vaccine

Fecal (stool sample)

Heartworm test/prevention

Your Cat's Medical History

Rabies Vaccine

FVRCPC Vaccine

Feline Leukemia Vaccine

FIP Vaccine

Fecal (stool sample)

Feline Leukemia Test

Second Pet Information

Do you give us permission for us to your pet's picture in our advertising?*

Yes

No

Pet's Name*

Breed*

Age / DOB*

Color*

Sex*

Male

Neutered Male

Female

Spayed Female

Species*

Dog

Cat

Would you like to add a third pet?*

Yes

No

Your Second Pet – Dog's Medical History

Rabies Vaccine

DA2PP+CVK Vaccine

Kennel Cough Vaccine

Lyme Disease Vaccine

Fecal (stool sample)

Heartworm test/prevention

Your Second Pet – Cat's Medical History

Rabies Vaccine

FVRCPC Vaccine

Feline Leukemia Vaccine

FIP Vaccine

Fecal (stool sample)

Feline Leukemia Test

Third Pet Information

Do you give us permission for us to use your pet's picture in our advertising?*

Yes

No

Pet's Name*

Breed*

Age / DOB*

Color*

Sex*

Male

Neutered Male

Female

Spayed Female

Species*

Dog

Cat

Your Third Pet – Dog's Medical History

Rabies Vaccine

DA2PP +CVK Vaccine

Kennel Cough Vaccine

Lyme Disease Vaccine

Fecal (stool sample)

Heartworm test/prevention

Your Third Pet – Cat's Medical History

Rabies Vaccine

FVRCPC Vaccine

Feline Leukemia Vaccine

FIP Vaccine

Fecal (stool sample)

Feline Leukemia Test

Additional Information

Previous Veterinarian/Hospital*

Any previous serious illness or surgeries?*

Any allergies to vaccinations or medications?*

Is your pet on any special diets or medications?*

Yes

No

If yes, please explain*

How did you become aware of our clinic?*

Yellow Pages

Internet Search/Website

Hospital Sign

Newspaper Ad

Personal Recommendation

Other

Who may we thank*

If other, please explain*

All fees are due at the time services are rendered.

Please indicate choice of payments*

Cash/Check

VISA

MasterCard

Discover

American Express

CareCredit

ScratchPay

Social Media Policy

I give Metropolitan Veterinary Center permission to photograph my pet and use their photo for promotional purposes, including on the website, Facebook, Instagram, and on other media outlets.

Yes

No

Signature*

Date*

MM slash DD slash YYYY

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36759 Mound Rd,
Sterling Heights, MI 48310

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Tuesday

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Wednesday

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Thursday

8:00am - 7:00pm

Friday

8:00am - 5:00pm

Saturday

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Sunday

Closed

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