Katoomba Veterinary Clinic

59 Waratah street
Katoomba, NSW 2780

(024)782-3273

katoombavets.com

New Client Check In

 

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

 

New Client

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)
Mobile Phone
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months (required)

Sex: (required)
Male
Female
Unknown


Type of Pet (required) :
Breed:

Desexed? (required)
Yes
No


Does your pet have previous medical records?
Are your pets vaccines current?
Medical records at another veterinary Practice? (please add their details) (required)
Yes
No


Name of Former Veterinary Practice and contact number

Reasons or conditions that prompted your visit?

Please list any additional pets here

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