Katoomba Veterinary Clinic

59 Waratah street
Katoomba, NSW 2780

(024)782-3273

www.katoombavets.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.

Name (required)

First Name (required)	Last Name (required)

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

Mobile Phone
Phone Type	Phone Number

E-Mail Address (required) :

Pet's Name (required)

Age: Years, Months (required)

Sex: (required)

Male
Female
Unknown

Type of Pet (required) :

Breed:

Desexed? (required)

Yes
No

Does your pet have previous medical records?

Are your pets vaccines current?

Medical records at another veterinary Practice? (please add their details) (required)

Yes
No

Name of Former Veterinary Practice and contact number

Reasons or conditions that prompted your visit?

Please list any additional pets here

How did you hear about us

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