2939 Mather Field Road
Rancho Cordova, CA 95670
(916) 363-9443
Cordova Veterinary Hospital
2939 Mather Field Road
Rancho Cordova, CA 95670
(916) 363-9443

 

The New Client Check In and Request an Appointment

lf you would like to make an appointment, you can complete this form and click submit this form below. We will contact you to set up an appointment. 

Also you can call (916) 363-9443 directly to make an appointment and provide the new client information when you arrive. Please allow an additional 15 minutes prior to your appointment to set up your patient file.

To save you time at check in, you may wish to complete the form below, print the page and bring it with you after making an appointment.  The doctors and staff at Cordova Veterinary Hospital always welcome new clients and their pets.

Form - Cordova Vet Hospital Client Form

Name & Email (required)
First Name (required)
Last Name (required)
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)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed, Color

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Are your pets vaccines current?
Do you have pets 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

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Cordova Veterinary Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Cordova Veterinary Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree
I Disagree


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