Online Check-in Form

KC Animal Hospital

& Pet Resort

10607 North Frank Lloyd Wright Blvd.

Suite J201

Scottsdale, AZ 85259

480-451-8375

Fax 480-451-2695

info@kcanimalhospital.com

Hours:

Monday-Friday 7:30am to 6:00pm

Saturday 8:00am to 1:00pm

Closed Sunday

We encourage any questions or feedback!

E-mail us at

practicemanager@kcanimalhospital.com.

CareCreditÃƒÆÃÙÃ†ÃÃƒÆÃ¢ÂšÃÂ¢ÃÂÅ¡ÃƒÆÃÙÃÂ¢ÃÂÅ¡ÃƒÆÃ¢ÂšÃƒâÃ‚ÃÂ® Veterinary Credit Cards: Feel good about giving the best care to your best friend / We offer flexible payment options

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooporation in letting us assist you.

Form - New Client Forms

Client Name (required)
First Name (required)	Last Name (required)

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

E-Mail Address (required) :

How did you hear about KC Animal Hospital? (required)

If you found us from a referral, whom may we thank?

If you found us on the internet, which search engine/keywords?

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

Pet #1 Name (required)

Pet's Age: In weeks or years (required)

Species (required)
Canine
Feline
Avian
Reptile
Other

Breed: (required)

Color: (required)

Sex: (required)
Male
Female

Is your pet spayed or neutered? (required)
Yes
No

Pet # 2 Name

Pet Age

Species
Canine
Feline
Avian
Reptile
Other

Breed

Color

Sex
Male
Female

Is your pet spayed or neutered?
Yes
No

Please check if your pets' vaccines are up to date.

Please check if you have medical records available for your pet.

Name of Former Veterinary Practice

City of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

Please list any additional pets here

Please Read:
I hereby authorize the veterinarians on staff at KC Animal Hospital to examine, prescribe for, and/treat the above described pet. I confirm that I am the owner or the owner's authorized agent and that I will be respondible for all charges incurred in the care of this animal. I understand that all fees are due at the time services are rendered.

I have read this statement and - (required)
I Agree
I Disagree

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KC Animal Hospital & Pet Resort

10607 North Frank Lloyd Wright Blvd. Suite J201

Scottsdale, AZ 85259 (480)451-8375