Skip to main content
New clients

New client & pet form.

Fill it out online and we'll have you in the system before your first visit — or print it and bring it with you. Add every pet in your household to this one form.

R Veterinary — Columbia · 400 Nebraska Ave, Columbia, MO 65201 · (573) 443-7274

Client information

First name *
Last name *
Email *
Spouse's name
Address
City
State
ZIP
Cell phone
Home phone
Work phone
Place of employment
How did you learn of our clinic? (check any that apply)
If recommended, by whom?
May we release pet records / your contact info when requested? (other vet clinics, boarding & grooming, shelters, or someone who finds your lost pet — Missouri requires your consent)
May we post photos of your pet on the clinic's social media?

Pet information #1

Pet's name *
Species
☐ Dog ☐ Cat ☐ Other
What would you like to schedule for this pet?
☐ Wellness exam & vaccines ☐ Sick or injured visit ☐ Dental ☐ Spay or neuter ☐ Just establishing care (no appointment yet) ☐ Something else
Breed
Color
Sex
Spayed / neutered?
Birthdate or approximate age
Where did you get your pet?
Diet / food
Current medications
Vaccination history (approximate dates of last vaccinations/procedures — Rabies, Parvo/Distemper, FVRCP, Bordetella, …)
Anything you've noticed or want us to know? (appetite, weight changes, concerns)

I authorize the veterinarian to examine, prescribe for, or treat the animals I present, and I assume responsibility for all charges incurred, due at the time of release. A deposit may be required for surgical treatment.

Signature of responsible party
Date