If this is your first time taking your cat or dog to see our vets at Mill Plain Veterinary Clinic please complete and submit our New Patient Form below.

New Patient Form

IMPORTANT: Please call our office to book an appointment before filling out this form.

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email *

Primary Phone *

Mobile Phone

Work Phone

Address *

City *

State *

Zip Code *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Mill Plain Veterinary Clinic to obtain and/or release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

By submitting this form, I hereby authorize Mill Plain Veterinary Clinic to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Mill Plain Veterinary Clinic.

Spam Blocker

Patients

Patient Information
New Patient Form
Pet Care Tips
Financing Options

Happy Tails from Clients

We've been with Mill Plain Vet for 20 years now, and would never go anywhere else. We have complete faith in the doctors and staff. When a care decision has to be made, all of the options are clearly and thoroughly explained, and they are always thinking in your pet's best interest, and not what might be most financially advantageous for them. I highly recommend them!
Steve

New Patient Form

New Patient Form

IMPORTANT: Please call our office to book an appointment before filling out this form.

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

New Patients Welcome

Welcoming Patients from Noah's Ark Animal Hospital