Cottage Grove Veterinary Clinic

Cottage Grove Veterinary Clinic - Cottage Grove, OR - New Client

1221 E. Main St.
Cottage Grove, OR 97424

(541)942-9181

www.cgvetclinic.com

New Client Request

Thank you for your interest in becoming a client. At this time, Dr Damewood is not accepting new patients. If you need immediate attention to your pet, it is best to call the clinic at 541-942-9181. Thank you for your cooperation in letting us assist you.

New Client

Name *(required)*

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

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

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address :

Pet's Name (required)

Age: Years, Months

Type of Pet (required) :

Breed:

Sex: (required)

Male
Female

Neutered/Spayed

Neutered
Spayed

Are your pets vaccines current?

Do you have pets medical records?

Medical records at another veterinary Practice?

Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No

Would you like us to call you for your appointment

Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

Please list any additional pets here

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If you have an emergency outside of our regular business hours, we recommend that you contact the local emergency hospital:

Emergency Veterinary Care | Emergency Veterinary Hospital (emergencyvethosp.com)