503-636-3001 reception@oswegovet.com

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NEW CLIENT FORM

Complete your form online!

Want to save time during your next visit to Oswego Veterinary Hospital? Be sure to complete the form below and you’ll be ready to go during your next visit! We look forward to seeing you soon!

Primary Owner Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Owner Email *

Primary Owner's Phone Number *

Please select the type of phone number: *

Cell
Landline

Co-Owner Name

First

Last

Co-Owner Phone Number

Please select the type of phone number:

Cell
Landline

Co-Owner's Email

Would you like the co-owner to receive text/email communications regarding your pet?

Yes - Text
Yes - Email
No

Emergency Contact Name

First

Last

Emergency Contact Phone

Please select the type of phone number:

Cell
Landline

Please list any additional contact people and phone numbers that you would like reflected in your account with us

How did you first learn of our hospital? We would like to thank any individual who referred you. *

Photo and pet name release: By checking below, I hereby give Oswego Veterinary Hospital the right to use the name, video and photograph of any of my pets in connection with its website and any promotional materials in any and all media, including printed material, internet, social media, and film for display, public relations and marketing. I hereby acknowledge receipt of adequate consideration and waive the right (i) to charge or be compensated for use of the pictures, and my pet(s)’s name and (ii) to inspect or approve the images prior to any form of usage. I understand that the images may be modified to use as design elements. *

I have read and give permission
I have read and DO NOT give permission

Pet #1 Name *

Pet #1 Breed *

Pet #1 Color *

Pet #1 Age/Date of Birth *

Pet #1 Sex *

Male
Female

Pet #1 Spayed or Neutered? *

Yes
No

Pet #1 Medical History, Allergies, or anything else we should know: *

Do you have another pet to add to your account? *

Yes
No

Additional Pet Name *

Additional Pet Breed *

Additional Pet Color *

Additional Pet Age/Date of Birth *

Additional Pet Sex *

Male
Female

Additional Pet Spayed or Neutered? *

Yes
No

Additional Pet Medical History, Allergies, or anything else we should know: *

Do you have another pet to add to your account? *

Yes
No

Additional Pet Name *

Additional Pet Breed *

Additional Pet Color *

Additional Pet Age/Date of Birth *

Additional Pet Sex *

Male
Female

Additional Pet Spayed or Neutered? *

Yes
No

Additional Pet Medical History, Allergies, or anything else we should know: *

Do you have another pet to add to your account? *

Yes
No

Additional Pet Name *

Additional Pet Breed *

Additional Pet Color *

Additional Pet Age/Date of Birth *

Additional Pet Sex *

Male
Female

Additional Pet Spayed or Neutered? *

Yes
No

Additional Pet Medical History, Allergies, or anything else we should know: *

Do you have another pet to add to your account? *

Yes
No

Additional Pet Name *

Additional Pet Breed *

Additional Pet Color *

Additional Pet Age/Date of Birth *

Additional Pet Sex *

Male
Female

Additional Pet Spayed or Neutered? *

Yes
No

Additional Pet Medical History, Allergies, or anything else we should know: *

All professional and medical services must be paid in full at the time they are rendered. We accept checks, credit cards, debit cards, Care Credit, most pet insurance and cash. As a pet guardian, you will be held liable for the financial responsibility of services that are performed for each pet. Unpaid balances will be recovered as deemed appropriate by Oswego Veterinary Hospital management. A 2.0% monthly interest fee will be charged on all unpaid balances. *

I am 18 or older and I understand and abide by the above statements.

Do you already have a scheduled appointment with us? *

Yes
No

A deposit in the amount of the examination cost is required at booking. If you have not already scheduled an appointment with us, one of our client care coordinators will be reaching out to you to schedule your requested appointment and take the deposit.

Are you interested in setting up an initial appointment with us? *

Yes
No, please just keep our information on file for future visits

What does your pet need to be seen for? *

What previous veterinary clinics/hospitals can we request prior medical history from? Please list all locations your pet has been seen at. *

Digital Signature *

Date *

Message

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