We are welcoming new clients and new patients to our practice during open office hours by appointment.
DO NOT use this application if your pet is ill or is having an emergency! If your pet is ill or having an emergency please call us at 814-474-1504. If we are closed then please contact the Northwestern PA Pet Emergency Center at 814-866-5920.
Complete and submit this form to contact us regarding wellness care or elective procedures (for example: vaccine, spay, neuter, yearly wellness exam). You will be contacted within two business days by our receptionist who will provide the estimates you may need, and will help you schedule your pet’s appointment.
New Client / New Patient Application
Name: Address: City:ST:Zip: Phone #: FAX: E-Mail:
Pet's Name: Pet's Breed: Pet's Age: Pet's Gender: Female Female (spayed) Male Male (neutered)
Pet Type: Family Pet Show Pet Working Dog
How were you referred to Fairview Veterinary Hospital? Phone Book Friend Self-Referred Referrer's Name:
What kind of wellness care does your pet need? (be as specific as possible)
When did you first get your pet, and where is s/he from?
Please list all medications (including dosages), holistics, and supplements that your pet is taking:
Does your pet have any other ongoingillnesses or health issues?
Is your pet allergic to any medications or anesthetics?
