New Client Registration Form – Animal Wellness Center Of White Cloud

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New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible to help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Social Media
- Clinic Sign
- Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex*
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
What vaccines were given at this time
Previous Records
We will contact you to request a copy of your pet's previous veterinary records prior to their first appointment. Please feel free to upload a copy of them now.
Accepted file types: jpg, pdf, png.
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet
Appointment Request
If you would like to request an appointment now, please fill out the sections below. This is not an automatic process, and it may take us 24-48 hours to process your request. Please feel free to call our office if you have not received an appointment confirmation within 48 hours.
Preferred Date
Date Format: MM slash DD slash YYYY
Preferred Time

: HH

MM
Alternative Dates or Times
Appointment Reason
Appointment Confirmation Preference
How would you like us to contact you with confirmation after we've scheduled the appointment?
- Give me a call
- Send me a text
- Send me an email

Δ

Contact

(231) 689-0630
info@whitecloudvet.com

Address

234 South Charles Street
White Cloud, MI 49349

Hours

Mon, Tue, Wed: 8 am – 5 pm
Thur: 8 am – 6 pm
Fri: 9 am – 5 pm
Sat: by appointment only | Sun: closed

© 2026 Animal Wellness Center Of White Cloud.
Provided by Patterson | Powered by LifeLearn WebDVM

Home
New Clients
- New Client Registration Form
About Us
- Our Team
Services
- Kitten Wellness Programs
- Puppy Wellness Programs
Pet Health
Contact Us
- Request An Appointment
- Prescription Refill and Food Order Request Form
Online Pharmacy
- Purina ProPlan VetDirect
- Pet Supply Store

facebook