New Client

Okaw Veterinary Clinic

140 W. Sale
Tuscola, IL 61953

(217)253-3221

www.okawvetclinic.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

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Spouse/Other

First Name	Last Name

Address (required)
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Home phone (required)
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Cell phone
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Place of Employment

Work phone
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E-Mail Address :

Pet's Name (required)

Age: Years, Months

Type of Pet (required) :

Breed:

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Date of last vaccinations:

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Name of Former Veterinary Practice

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Has your pet had any previous surgeries or medical problems?

Is your pet on any medications? If so, list medications below.

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Please list any additional pets here

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Okaw Veterinary Clinic
140 W. Sale
Tuscola, IL 61953
(217) 253-3221

okawvetstaff@mchsi.com

Hours:
Mon & Fri 8 am - 7 pm
Tues & Wed 8 am - 5 pm
Sat 8 am - noon
Closed Thurs & Sun

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