New Pet for Existing Client Form ΔExisting Client NameInformation about youFirst Name Last Name New Patient Information Information about your pet(s)Name of New Pet 1 Birthdate or Approximate Age Species Dog Cat OtherBreed Sex Spayed Female Intact Female Neutered Male Intact MaleColor How Acquired Rescue/Shelter Organization Breeder Found Stray Pet Store Family/Friend OtherDoes this pet have an insurance policy? Yes NoName of Insurance Provider What is covered (check all that apply) AccidentIllnessWellness/Preventative CarePrescription MedicationPrescription Food/SupplementsHereditary/Congenital ConditionsChronic ConditionsPast Medical Issues (allergies, chronic conditions, behavioral, surgical procedures, etc.) Current Medications or Prescription Diets (Dosage and Frequency) Heartworm and Flea & Tick Prevention (Type and Approx. Last Dose) Does this pet have medical records at another veterinarian? Yes NoPast Veterinary Clinic Info How should we acquire past medical records? I have access to the records and will email them to you at CHVteam@charlestonvets.com 24 hours+ prior to my first visit I have hard copies of the records and will bring them to the clinic at least 1 business day before my visit Please contact the past veterinarian on my behalf (may sometimes cause delays if clinic is unresponsive)May we use your pet's name and image on social media and other marketing materials? Yes NoList any social media accounts for you or your pet you would like us to tag Do you have an additional pet to add to your account? Yes NoNew Pet #2 InformationName of New Pet 2 Birthdate or Approximate Age Species Dog Cat OtherBreed Sex Spayed Female Intact Female Neutered Male Intact MaleColor How Acquired Rescue/Shelter Organization Breeder Found Stray Pet Store Family/Friend OtherDoes this pet have an insurance policy? Yes NoName of Insurance Provider What is covered (check all that apply) AccidentIllnessWellness/Preventative CarePrescription MedicationPrescription Food/SupplementsHereditary/Congenital ConditionsChronic ConditionsPast Medical Issues (allergies, chronic conditions, behavioral, surgical procedures, etc.) Current Medications or Prescription Diets (Dosage and Frequency) Heartworm and Flea & Tick Prevention (Type and Approx. Last Dose) Does this pet have medical records at another veterinarian? Yes NoPast Veterinary Clinic Info How should we acquire past medical records? I have access to the records and will email them to you at CHVteam@charlestonvets.com 24 hours prior to my first visit I have hard copies of the records and will bring them to the clinic at least 1 business day before my visit Please contact the past veterinarian on my behalf (may sometimes cause delays if clinic is unresponsive)May we use your pet's name and image on social media and other marketing materials? Yes NoList any social media accounts for you or your pet you would like us to tag Submit Form