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Ketchikan, AK: 907-313-7911
Text Us At: 907-313-7911
Craig, AK: 907-313-3953
Text Us At: 907-313-3953
Emergencies

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New Patient Information Form

Welcome to Island to Island Veterinary Clinic. Our staff is dedicated to the optimum in patient care and will do its utmost to make your pet’s stay pleasant and beneficial. Please feel free to ask any questions concerning the treatment of your pet or other policies of the clinic. To help us serve you better, please provide us with the following information.

Name(Required)

First Last

Home Phone

Work Phone

Cell Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Spouse's Name

Spouse's Work Phone

Spouse's Cell Phone

Place of Employment

Spouse's Place of Employment

Please select from the below list (if applicable):

Military

Senior Citizen

Pet #1 Information

Name(Required)

Breed(Required)

Color(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Rabies Tag Number

Microchip Number

Sex(Required)

Female

Female - Spayed

Male

Male - Neutered

Any previous illnesses or surgeries?(Required)

Any allergies to vaccinations or medications?(Required)

Is your pet on any special diets or medications?(Required)

Do you have any more pets?

Yes

No

Pet #2 Information

Name(Required)

Breed(Required)

Color(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Rabies Tag Number

Microchip Number

Sex(Required)

Female

Female - Spayed

Male

Male - Neutered

Any previous illnesses or surgeries?(Required)

Any allergies to vaccinations or medications?(Required)

Is your pet on any special diets or medications?(Required)

Do you have any more pets?

Yes

No

Pet #3 Information

Name(Required)

Breed(Required)

Color(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Rabies Tag Number

Microchip Number

Sex(Required)

Female

Female - Spayed

Male

Male - Neutered

Any previous illnesses or surgeries?(Required)

Any allergies to vaccinations or medications?(Required)

Is your pet on any special diets or medications?(Required)

Payment is due at the time services are rendered

I understand that the hospital staff will provide an estimate of current and anticipated charges at the time services are provided. I am requesting that veterinary care be provided for the pets presented by me or my agents. I understand that I am financially responsible for all services provided.

Signature of Owner or Agent

69470

Ketchikan Veterinary Clinic

355 Carlanna Lake Rd
Ketchikan, AK 99901

Phone: (907) 313-7911

Mon & Fri: 8am-4pm
Tue / Wed / Thur: 8:30am-5pm
Sat & Sun: Closed

Craig Pet Boutique

400 JS Drive
Craig, AK 99921

Phone: (907) 313-3953

Tues – Fri: 11am-4pm
Sat & Sun: Closed

© 2024 Island to Island Veterinary Clinic. Designed & Managed by ViziSites. Terms of Use.

Home
About Us
Locations
- About Ketchikan Vet Clinic
- About Craig Pet Boutique
Our Services
- Veterinary Services
- Boarding
Pet Owners
Education
Contact

Ketchikan, AK: 907-313-7911
Text Us At: 907-313-7911
Craig, AK: 907-313-3953
Text Us At: 907-313-3953
Emergencies

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