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Welcome. Thank you for giving us the opportunity to care for your pet. Please help us meet your needs by taking a moment to complete this information form.

At your request we will gladly discuss cost of services and prepare a written estimate for recommended procedures. All fees are due at the time services are rendered. We accept cash, debit cards, Visa, MasterCard, Discover Card and Care Credit.

We are your Veterinarian in Poulsbo/Bremerton/Silverdale

Click here if you would prefer download this form.

Patient/Client Information


How do you prefer to be notified of reminders?

How did you first learn about our hospital? We would like to thank the individual who referred you.


  • Pets Name

  • Cat or Dog?

  • Breed

  • Description/color

  • Age

  • Sex/Altered?

  • Length of Time Owned

  • How Obtained?

  • Previous Hospital/Vet

  • Current Medication

  • Special Diet

  • Prior Illness/Accidents

  • Prior Surgery/Dentistry

By submitting this form, I hereby authorize the veterinarian to examine, prescribe for, and/or treat the pets above described pets. I assume full responsibility for all charges insured for the care of my pets. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

We are your Veterinarian in Poulsbo/Bremerton/Silverdale

Thanks for submitting!

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