New Client

Okaw Veterinary Clinic LLC

140 West Sale Street
Tuscola, IL 61953

(217)253-3221

www.okawvetclinic.com

New Client Check In

Welcome! Feel free to fill out the form below or print the "New Client" and "New Patient" sheets on the bottom of this page and bring them in to our clinic.

If you submit the form below, we will reach out to you as soon as we are available. Thanks for your interest in our clinic!

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
Closed Thurs, Sat, & Sun

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