Online Check-in Form

KC Animal Hospital & Pet Resort

Serving North Scottsdale

10607 North Frank Lloyd Wright Blvd.

Suite J-201

Scottsdale, AZ 85259

(480) 451-8375

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's Name

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

Type of Pet (required)
Canine
Feline
Avian
Reptile
Other

Breed: (required)

Color: (required)

Sex: (required)
Male
Female

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

Please check if your pet's vaccines are up to date.

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

Name 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

The verification code below ensures the form is not submitted by a computer

Verification Code :

Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.