Cane River Veterinary Wellness Clinic

660 West Main Street
Burnsville, NC 28714

(828)682-7710

www.canerivervet.com

NEW CLIENT CHECK-IN

At this time we are practicing curbside services. If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Please call the office from the parking lot when you arrive. Please do NOT walk in with your pet. We will come out to get your pet and speak with you.

New Client

Name & Email (required)
First Name (required)
Last Name (required)
E-Mail Address :
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pet's vaccines current?
Do you have your pet's medical records?
Medical records at another veterinary practice?

Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No


Would you like us to call you for your appointment?
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

WE REQUIRE A $50 NON-REFUNDABLE DEPOSIT TO HOLD AN APPOINTMENT. PAYMENT IS DUE AT THE TIME OF SERVICE. NEW CLIENTS WHO DO NOT SHOW UP FOR AN APPOINTMENT WILL NOT BE RESCHEDULED.
I have read the above statement and agree that I understand. (required)

Yes, I agree


Cane River Veterinary Wellness Clinic is working via curbside services. You will not be able to enter the clinic with your pet. Please mark the box stating that you understand. (required)

Yes, I agree



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Dr. Stacy Jones
660 West Main Street
Burnsville, NC 28714
(828)682-7710

Dr. Stacy Jones
660 West Main Street
Burnsville, NC 28714
(828)682-7710