Silver Creek Animal Clinic LLC

P.O. Box 1620
Silverton, OR 97381


New Client Information and New Client Appointment Request Form

If you are a new client and would like to make an appointment, you can assist us to expedite your check in by submitting this form. If you're an existing client and want to request an appointment, please use that form instead.

Thank you for your cooperation in letting us assist you.

New Client Information Form

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months (required)

Type of Pet/Animal (required) :
Breed: (required)

Sex: (required)


Neutered/Spayed (required)


Are medical records available at another Veterinary Practice? (required)


Name of Former Veterinary Practice? (required)

May we request a transfer of records? (required)


Would you like us to call you for your appointment?
Reason(s) for appointment (please give as much detail as possible)?

Special requests or conditions?

Please list any additional pets here

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