New Client

Okaw Veterinary Clinic LLC

140 West Sale Street
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.

Name (required)

First Name (required)	Last Name (required)

Spouse/Other

First Name	Last Name

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Home phone (required)
Phone Type	Phone Number (required)

Cell phone
Phone Type	Phone Number

Place of Employment

Work phone
Phone Type	Phone Number

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:

Do you have your pet's medical records?

Name of Former Veterinary Practice

Reasons or conditions that prompted your visit?

Has your pet had any previous surgeries or medical problems?

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

How did you hear of us?

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 - 6 pm
Tues & Wed 8 am - 5 pm
Sat 8 am - noon
Closed Thurs & Sun

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