Owner's Name *

First

Last

Spouse/Co-Owner's Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Required for reminders

Primary Phone *

May we text this number? *

Yes
No

Spouse/Co-Owner's Primary Phone

May we text this number?

Yes
No

Employer

Employer's Phone Number

Owner's Date of Birth *

Pet Information

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Does your pet have a microchip? *

Yes
No

Microchip Number *

Is your pet current on their vaccines? *

Yes
No

If yes, where and when did they receive them? *

Any Previous Medical Concerns/History?

Add a second pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Does your pet have a microchip? *

Yes
No

Microchip Number *

Is your pet current on their vaccines? *

Yes
No

If yes, where and when did they receive them? *

Any Previous Medical Concerns/History?

Can we post/share photos of your pet(s) on social media? *

Yes
No

PAYMENT IS EXPECTED AT THE TIME OF SERVICE - We accept Cash, Visa, MC, Discover, American Express, Care Credit, and Trupanion Insurance. *

I have read and understand

We require 24-hour notice for ALL cancellations or reschedules. If you cancel or reschedule without a 24-hour notice or no-show for your appointment, a deposit will be required in order to reschedule, and a no-show fee will be applied. *

I have read and understand

I hereby authorize the veterinarians at Puyallup Valley Veterinary Clinic to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I understand that these charges must be paid at the time of release and that a deposit may be required for surgical procedures and treatment. *

I authorize

Signature *

Clear Signature

Date *

Online Forms

New Client Form

New Client Form

Pet Information

Get in Touch

Contact Us

Address

Contact

Hours