New Client Information Please fill out the form below as completely and accurately as possible to help us get to know you and your pet before your first visit! If you have any questions, please contact us at (360) 694-5030. Name *FirstLastEmail *Phone Number *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSpouse's NameFirstLastSecondary or Spouse's PhoneHow did you hear about us?Would you like to receive email reminders? *YesNoPet's Name *Pet's Date of Birth/Age *Pet Species *DogCatExoticBreed (if applicable)Sex *MaleFemaleNeutered MaleSpayed FemaleUnknownColorCurrent MedsPrior VeterinarianMay we use photos of your pet for our social media pages and/or website? *Yes, you have my permission to use my pet's photos.No, you do NOT have my permission to use my pet's photos.Add a photo of your pet to keep on file!Would you like to add information for another pet at this time? *YesNoPet's Name *Pet's Date of Birth/Age *Pet Species *DogCatExoticBreed (if applicable)Sex *MaleFemaleNeutered MaleSpayed FemaleUnknownColor Current MedsPrior VeterinarianMay we use photos of your pet for our social media pages and/or website? *Yes, you have my permission to use my pet's photos.No, you do NOT have my permission to use my pet's photos.Add a photo of your pet to keep on file!WebsiteSubmit REQUEST APPOINTMENT WellHaven Pet Health Mill Plain 906 SE 164th Ave., Suite 100 Vancouver, WA 98683 360-694-5030