New Client Application

We require an examination with our doctor prior to scheduling any surgical or dental procedures.

Name *

First

Last

Occupation *

2nd Owner

First

Last

Occupation

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

How did you hear about us? *

Referred by:

Would it be okay to take pictures of your pet(s) for our social media? *

Pet Info

Pet's Name *

Age *

Breed *

Does your pet have a microchip identification? *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Do you have a 2nd pet? *

Pet's Name *

Age *

Breed *

Does your pet have a microchip identification? *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Do you have a 3rd pet? *

Pet's Name *

Age *

Breed *

Does your pet have a microchip identification? *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Do you have a 4th pet? *

Pet's Name *

Age *

Breed *

Does your pet have a microchip identification? *

Sex *

Male
Neutered Male
Female
Spayed Female

Color *

Please list previous veterinarian(s) we can contact for medical records

Does your pet have insurance? *

Insurance Company: *

I am the owner/authorized agent for the pet (s) listed on this form. I understand that I am financially responsible for any services/products provided and payment in full is due at the time services are rendered. *

I have read and understand.

Signature *

Clear Signature

Date *

Comment

Have a question?

Complete the form below and our team will be in touch with you shortly. If you need immediate assistance during business hours, please text or call us directly at 509-588-6970.

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Phone Number

509-588-6970

Email

sunriseveterinaryclinic@gmail.com

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Address

510 9th Street
Benton City, WA 99320

Get Directions

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Hours

Mon: Closed
Tues - Fri: 7:30 AM – 5:30 PM
Sat, Sun: Closed

Name *

First

Last

Email *

Phone *

How can we help you? *

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