To help us get ready for your visit and keep things running seamlessly when you arrive, please fill out the new client information form. We really appreciate it - and we’re looking forward to meeting you and your furry friend!

Exterior view of a commercial building with a white facade, red stripe, and red lettering that reads "Denny's" on a sunny day, with green grass, trees, and a blue sky.

Name *

First Name

Last Name

Spouse or Co-Owner

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Alt. Phone

(###)

###

####

Owner's Driver's License or State ID Number *

This information is required to prescribe certain medications.

Owner's Date of Birth *

This information is required to prescribe certain medications.

YYYY

Pet's Name *

If you have more than one pet, feel free to add their info in the message box at the bottom of this form - or tell us about them at your visit!

Pet's Sex *

Male

Female

Male/Neutered

Female/Spayed

Pet's Breed, Color, and Age/Birthday *

Has your pet been diagnosed with any of the following conditions? *

Please check all that apply.

No current concerns

Allergies/Atopy

Arthritis

Behavioral Issues

Cancer

Chronic Ear Infections

Diabetes

Gastrointestinal Conditions

Heart Disease

Hyperthyroidism/Hypothyroidism

Kidney Disease

Liver Disease

Seizures

Is your pet currently experiencing any of the following symptoms? *

Please check all that apply.

No current concerns

Behavioral Changes

Coughing or Sneezing

Decreased/Increased Appetite

Diarrhea/Loose Stool

Difficulty/Labored Breathing

Increased Thirst or Urination

Itching or Excessive Scratching

Limping or Lameness

Lethargy

Shaking Head or Ear Discomfort

Swelling or Lumps

Vomiting

Weight Changes

Has your pet been vaccinated in the last year? *

Yes

May we use your pet's likeness on social media or our website? *

Yes

How did you hear about us? *

Anything else you'd like to share?

Feel free to add any other details you feel may be helpful.

Consent to Share Information *

Checking this box signifies your agreement to share your information with us in accordance with our Privacy Policy and acknowledges your understanding of how it will be used.

I Agree

Financial Responsibility and Payment Acknowledgement *

To help us provide the best care possible, we kindly ask that all services be paid for at the time they are provided. We’re not able to offer billing or delayed payments. By proceeding, you acknowledge that you are at least 18 years old and financially responsible for any services rendered during your visit.

I Understand

Thank you for taking the time to fill out the new client information form.

We look forward to seeing you and your pet soon!