Skip to content
208-336-3278
Online Pharmacy
hours
location
COVID-19 Updates
Today: 7:30 am - 5:30 pm
Open Hours
208-336-3278
Phone Number
626 E. Boise Ave
Boise, ID, 83706
Home
Our Practice
Fear Free
Services
Hill’s To Home
Contact Us
Pet Corner
New Patient Form
Pet Health Records
Online Pharmacy
Payment Options
Pro Plan
Request an Appointment
today:2021-04-14
Great news! Eastgate Pet Clinic is now offering rattlesnake toxoid for dogs! Call 208.336.3278 to schedule your appointment today!
×
New Pet Registration Form
Please complete one Pet Information Form for each of your pets.
Owners Name?
*
Email address?
*
Pet's Name?
*
Species?
*
Dog
Cat
Bird
Other
Breed?
Date of Birth or Approximate Age?
Sex
*
Male
Female
Unknown
Spayed Or Neutered
*
Yes
No
Unknown
Date or Age Pet was Spayed Or Neutered?
Description Of Your Pet (Color, Markings, Long Or Short Hair)
Microchip Or Tattoo Number If Present?
Do You Have A Copy Of The Pet’s Medical Record With You?
*
If you do not have a copy of your pet's medical record do you know when the pet was last vaccinated?
Cats:
Rabies Vaccination?
Rhino, Calici, Panleukopenia (FVRCP) Vaccination?
Feline Leukemia (FELV) Vaccination?
Feline Immunodeficiency (FIV) Vaccination?
Dogs:
Distemper, Parvo (DHPP)
Bordetella (Kennel Cough)
Leptospirosis (Lepto)
Lyme’s Disease
What Foods Do Your Pets Eat At Home? (Canned, Dry, Brand Name)
Have Any Of The Pets In Your Home Had Any Severe Illness In The Past, Such As Distemper, Parvo-Virus, Or Feline Infectious Peritonitis? If So, Please List.
Is Your Pet’s Currently Covered By A Pet Health Insurance Policy?
*
yes
no
Name Of Insurance?
Does Your Pet Have Any Medical Or Behavioral Problems You Are Aware Of? Any Known Reactions To Medications Or Anesthetics? Is There Anything Special About This Pet That We Should Be Aware Of?
If You Would Like Us To Request A Copy Of The Pet’s Previous Medical History From Another Veterinary Clinic, Please Provide A Name And Address, Or Phone Number