New Client Information Form in Knoxville, TN

We are happy you are considering us for your pet's new veterinarian.

This form is for new clients that have set up an appointment time by phone, PetDesk app, or our Request an appointment page. If you still need to schedule an appointment, please visit our Appointment Request page, download the PetDesk app, or call us at 865-691-8826. Thanks.

Owner's Name*

First Last

Spouse

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Preferred Phone*

Additional Phone

Email*

Reason for first visit with us? (Ex: vaccines, sick visit, etc)*

How did you hear about us?*

Payment is required at the time services are rendered. Please visit our Financial Page for any other information.

Pet information (all pets within household)

Pet #1*

Cat
Dog

Pet #1 Date of birth*

D/O/B

Pet #1 Info*

Pet Name Breed Color

Pet #1 Sex*

Male
Female

Pet #1 Fixed(Spayed or Neutered)*

Yes
No

Do you have more than one pet?*

Yes
No

Pet #2

Cat
Dog

Pet #2 Info

Pet Name Breed Color

Pet #2 Date of birth

D/O/B

Pet #2 Sex

Male
Female

Pet #2 Fixed?

Yes
No

Pet #3

Cat
Dog

Pet #3 Info

Pet Name Breed Color

Pet #3 Date of birth

D/O/B

Pet #3 Sex

Male
Female

Pet #3 Fixed?

Yes
No

Date of Last Vaccinations:*

Name of previous Veterinary Clinic*

We ask that all new clients provide previous vaccination records, or contact their previous veterinarian to send us a copy by fax or e-mail prior to your first visit. Some veterinary clinics now require pet owner pre-approval to release records to other veterinary clinics. (We must have a copy of the previous vaccination history from a licensed Veterinarian).

If records are not received vaccines will be given for boarding, bathing, and grooming.

BORDETELLA VACCINE IS REQUIRED AT RHAH EVERY 6 MONTHS.

The undersigned affirms the information provided above is correct and agrees to all conditions as stated in the above paragraph

Type Full Name as Signature*

Date*