Home New Client Form

New Client Form

NEW CLIENT FORM

Thank you for giving Roseway Veterinary Hospital the opportunity to care for your pet(s). Please fill out the new client form below prior to your visit so we can expedite your pet’s appointment. If you have not yet scheduled an appointment, please contact us at 503-446-2450.

Get Started

NEW CLIENT FORM

You may complete the web form and submit it online below or click the button to download it and submit it via email before your pet’s appointment.

How to download and email the PDF form:

Open the fillable PDF version of the form by clicking the button below.
Download the blank form to your computer. DO NOT complete the form in your web browser. The data will not save. Be sure to download the file to your computer first before you begin to fill out the form.
Complete the fillable PDF form using your computer’s PDF reader program.
Save the completed form as a new file and email it as an attachment to info@rosewayvet.com.

If you have any questions or issues with the form, please call us at 503-446-2450.

Download New Client Form

Owner Information

The first name listed on the account will be the first contact when we call for anything regarding your patient

Owner Name(Required)

Preferred Pronoun(s)

Address

City

Zip

Cell Phone(Required)

Alternate Phone

Email Address(Required)

Co-Owner

Relationship

Preferred Pronoun(s)

Co-Owner Phone

Co-Owner Email

Do you have an insurance policy- if so with whom?

How did you hear about us?

If personally referred, who may we thank?

Pet Information

Pet’s Name

Species

Dog

Cat

Date of Birth (Age)

Breed

Color

Sex

Male

Neutered Male

Female

Spayed Female

If a cat, please select

Indoor Only

Indoor/Outdoor

Outdoor Only

Where have they been seen previously? List all regular vet(s), emergency(s) and urgent care(s)

Microchip #

Current Diet

Allergies?

Any Behavioral History? i.e leash aggression, anxiety at the vet, dog or cat reactivity?

Medical Conditions Current or Historically

Current Medication(s)/Preventatives

Exposure/Travel History

All fees are due at the time services are provided. We accept MasterCard, Visa, Discover, Checks, and Cash as
payment. It is our policy to provide you with a written estimate of fees for any case where hospitalization,
emergency care, dentistry, or surgery will be provided. A deposit may be required prior to treatment.

PUBLICITY RELEASE: I authorize Roseway Veterinary Hospital to use my pet’s photo and first name in marketing materials, which may include but are not limited to, social media accounts like Facebook and Instagram, rosewayvet.com , in-hospital signage and other forms of advertising.(Required)

Owner Signature(Required)

Date

New Clients Welcome! Please fill out our online New Client/New Patient Form and/or email us at info@rosewayvet.com.

New Client Form

NEW CLIENT FORM

NEW CLIENT FORM

Owner Information

Pet Information

WE PROUDLY SERVE THE PETS OF PORTLAND, OR AND THE SURROUNDING AREAS:

Get in touch

503-446-2450

Business Hours