New Client
Questionnaire
New Client Questionnaire
Phone
number:
Your name:
Additional
name:
Address:
Email:
Address:
Town:
Zip Code:
State:
What animals do you have?
(check all that apply)
Dogs
Cats
Rabbits
Ferrets
Reptiles
Mice/Rats
Horse
Sheep
Pigs
Guinea Pigs
Hampsters
Cattle
Goats
Llama/alpaca
Birds
Other:
Is your pet new to your family?
Yes
No, then please answer question below
How often does your pet(s) go
to the veterinarian?
Once a year
Twice a year
More than twice a year
Only when sick
Never
Are any of your animals used
as or for food production?
No
Yes
