We encourage you to fill out our Patient Form using one of the options below if your information has changed since your pet's last appointment at Spinnaker Veterinary Clinic.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

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 Spinnaker Veterinary Clinic 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 Spinnaker Veterinary Clinic 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 Spinnaker Veterinary Clinic.

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Patients

Patients
Patient Form
Tips & Advice
CareCredit Financing

Request Appointment Refill Prescription Access to Pet Records 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

The staff is lovely to both our dogs and us. Dr. Flemming always breaks things down into easy-to-understand simple steps. Even though we moved a few towns over last year we still make the trek, they are worth it!
Melissa M.

Patient Form

Option 1

Complete Online

Option 2

Complete on Arrival

Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Welcoming Cats & Dogs to Our Animal Hospital