Owner Information

Owner First Name *

Owner Last Name *

Email *

Primary Phone *

Mobile Phone

Secondary Owner / Authorized Agent Name

Secondary Owner / Authorized Agent Phone

Address *

City *

State *

Zip Code *

Pet Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

Upload your previous records here if applicable

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Additional Pet Information

Pet Name

Birth Date / Age

Species

Colour

Breed / Other Species

Vaccination Status

Gender

Spayed or Neutered

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Do you have an appointment? *

Yes

No

Date of appointmet? (Enter N/A if not applicable) *

How do you plan to pay for your first visit?

Cash

Credit Card

Check

CareCredit or ScratchPay

Go Green *

Yes, I'd like to "Go Green" and only receive my pet’s reminders by email, PetDesk app, or text

No thanks, I still need the postal reminders

By submitting this form, I hereby authorize New Ulm Regional Veterinary Center to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from New Ulm Regional Veterinary Center.

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New Client Form

New Client Form

Owner Information

Pet Information

Additional Pet Information

Welcoming New Ulm Animals to our Animal Hospital