If this is the first time you are bringing your cat or dog to Sears Veterinary Hospital please fill out our New Patient Form using any one of the following methods.

Option 1

Fill & Submit Online

Complete and submit the following online form.

Option 2

Print & Complete

Bring the filled-out form with you to your appointment.

Download Form

Option 3

Complete on Arrival

Complete the form when you arrive at our hospital.

New Patient Form

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email *

Primary Phone *

Mobile Phone

Work Phone

Address *

City *

State *

Zip Code *

Employer *

Occupation *

Date of Birth *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Sears Veterinary Hospital to release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

By submitting this form, I hereby authorize Sears Veterinary Hospital 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 Sears Veterinary Hospital.

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Emergencies Patient Account Login Log in to your pet's patient account to book an appointment, refill a prescription, or access your pet's medical records.

Happy Tails from Clients

Our kitty was very sick. I didn't get the news I had hoped for, but after a 3-day ordeal, he is alive, home, happy and comfortable! Everyone there was super sweet. They took a lot of time to explain everything and answer questions. The Dr. is very straightforward, honest, and I didn't feel like I was pressured.
- Kim

New Patient Form

Option 1

Fill & Submit Online

Option 2

Print & Complete

Option 3

Complete on Arrival

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Welcome New Patients