1100 US-45 S, Eagle River, WI 54521

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- Meet the Doctor
New Clients
- New Client Form
Appointments
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Pet Portal
Contact

Home
About
- Meet the Doctor
New Clients
- New Client Form
Appointments
Services
Pet Portal
Contact

New Client Form

"*" indicates required fields

Dr.John's Dog and Cat Repair

Today Date

MM slash DD slash YYYY

Name*

First Last

Co-Owner

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Cell Phone number(s)*

Home phone number

Are you over 18?

Yes

No

How did you hear about Dr. John's ?

Pet Information

Pet's Name

Species

Dog

Cat

Breed

Color

Birthdate (approximate)

MM slash DD slash YYYY

Microchipped?

Yes

No

Chip number

Spayed/Neutered

Yes

No

Sex

M

F

Medical History

Is your pet taking any medication?

Yes

No

If so, please list

Canine Vaccinations

Please list last known date

Rabies

DHPP (Distemper)

Lyme

Leptospirosis

Bordatella

Feline Vaccinations

Please list last know date

Rabies

FVRCP

Leukemia

Other

Signature*

Date*

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

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Appointments

We will do our best to accommodate your busy schedule. Request an appointment today!

Make an Appointment

Pet Portal

Dr. John’s Dog and Cat Repair

Phone: (715) 337-2700 Address: 1100 US-45 S, Eagle River, WI 54521

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