Veterinary Forms | Edgewood Animal Clinic Skip to Main Content Skip to Footer

Download Our App|(541) 341-6558

Services
Hours & Location
About Us
Contact

Download Our App
(541) 341-6558

Services
Hours & Location
About Us
Contact

New Client Registration Form

Thank you for choosing Edgewood Animal Clinic to care for your pet. Filling out this form prior to your appointment will greatly assist us in adding you and your pet to our system.

We will be happy to contact your previous veterinarian to obtain any necessary information or documentation regarding your pet's medical history.

Co-Owner Name (first & last):

Co-Owner Phone Number:

Patient Information:

Pet's Name*

Age / DOB*

Species*

Breed*

Color*

Sex*

Female Intact

Female Spayed

Male Intact

Male Neutered

General Information

Previous Veterinarian and Phone Number*

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Reason for your pet's visit:*

Veterinarian Preference*

Jason Kimball, DVM

J. Scott Callahan, DVM

Suzanne Leduc, DVM, cVMA

No Preference

Edgewood Animal Clinic

4010 Donald Street
Eugene, OR 97405

phone: (541) 341-6558
fax: (541) 341-3921 • email us

Serving the Eugene, OR area, including (but not limited to): Springfield, Roseburg, Creswell, Cottage Grove, Veneta, Junction City, Veneta, and Coburg.

Make an Appointment Request a Refill

© 2024 Edgewood Animal Clinic. All rights reserved. View our Privacy Policy.