Spencerport Country Veterinarian, PC

1835 N Union St
Spencerport, NY 14559

(585)352-4040

www.spencerportcountryvet.com

***Current Clients Only***

                 New Furry Family Member Check In

Current clients who have just acquired a new furry family member that would like to make an appointment can assist us to expedite your check in by submitting this form. Please also drop off or email us any previous vaccine and/or medical history prior to your first visit.

Thank you for your cooperation in letting us assist you.

New Furry Family Member

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pets vaccines current?
Do you have your pet's previous medical records?
Medical records at another veterinary Practice?

Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here


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