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Existing Client Form

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Day of Your Appointment

Date *

Your First Name: *

Your Last Name: *

Phone: *

Email: *

Would you prefer an in-person visit or remain curbside? *In-Person VisitCurbside

Patient Information

Cat’s Name: *

Patient Visit

Reason for Visit: *ExamExam w/ Lab WorkExam w/ VaccinesIllness or InjuryRecheckBoostersOther

Please explain: *

Other Services: (All other services will be at an additional cost)Express Anal GlandsNail TrimShave MattsShave Rear

Your Cat’s Lifestyle *Indoor OnlyIndoor MostlyOutdoor OnlyOutdoor MostlyIn and Out Freely

Do you have any concerns with your cat? *NoneIncreased AppetiteDecreased AppetiteIncreased DrinkingDecreased DrinkingWeight LossWeight GainItching/ScratchingVomitingDiarrheaUrination IssuesLethargyBehavioralSneezingCoughingOther

Please explain: *

What brand and type of food do you feed your cat? *

How much/how often do you feed your cat? *Free FedMeasured Amounts

Is your cat on any current medications or supplements? *YesNo

If so, what name, dose and frequency of medications?

Do you have pet insurance? *YesNo

If so, what type of insurance does your cat have?

Do you have our app (PetDesk)? *

YesNo

IN PERSON VISIT – We ask that you remain seated for the examination and allow our trained assistants to provide physical support for your cat.

IF YOU ARE ILL OR HAVE BEEN EXPOSED TO SOMEONE WHO IS ILL, WE WILL NEED YOU TO REMAIN CURBSIDE OR RESCHEDULE YOUR APPOINTMENT *I understand and agree

Owner Signature: *

Please do not fill in this field.

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3100 N. College Ave.
Fayetteville, AR 72703
Phone: 479-571-1228

Monday: 7:30am-5:30pm
Tuesday: Closed
(alternates with Saturdays)
Wednesday: 7:30am-5:30pm
Thursday: 7:30am-5:00pm
Friday: 7:30am-5:30pm
Saturday: 7:30am-12:00pm
(alternates with Tuesdays)
Sunday: Closed

Emergency Clinic: Animal Emergency
and Specialty Clinic of NWA
881 Metroplex Dr.
Springdale, AR 72762
479-927-0007

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