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New Patient Form

Thank you for choosing Okaloosa Animal Clinic for your pet’s care! Help us get to know your pet before you arrive by completing our online new patient form.

GET STARTED

New Patient Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Spouse Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

Communication preference (check all that apply):

Email
Text
Phone

How would you like to receive your pet(s) reminders?

By Mail
By Email

May we use your pet(s) photo on our social media?

Whom may we thank for referring you?

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Emergency Contact Phone *

How did you find out about our hospital? If you were referred by someone, who should we thank?

Pet Information

Pet's Name *

Age or Date of Birth *

Sex *

Male
Female
Neutered Male
Spayed Female

Species (dog, cat, etc.) *

Color *

Breed *

Does your pet have a microchip identification?

Illnesses Birth you?

What is the microchip number?

Pet’s History or Any Illnesses

List Any Medications

Current on vaccines? *

Previous Weight *

Do you have a second pet? *

Second Pet's Name *

Age/Date of Birth *

Sex *

Male
Female
Neutered Male
Spayed Female

Species (dog, cat, etc.) *

Color *

Breed *

Does your pet have a microchip identification?

What is the microchip number?

Pet’s History or Any Illnesses

List Any Medications

Current on vaccines? *

Previous Weight *

File Upload

Click or drag a file to this area to upload.

Payment Information

Date *

Owner's Date of Birth *

Signature *

Clear Signature

Phone

Questions?

Get in touch! We look forward to hearing from you.

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Location

413 W James Lee Blvd (Hwy 90W)
Crestview, FL 32536

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Contact Information

Phone: (850) 682-2315
Email: info@okaloosavet.com

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Hours

Mon – Thu: 7:30 AM – 6:00 PM
Fri: 8:00 AM – 4:00 PM
Sat – Sun: Closed

Name *

First

Last

How can you?

Email *

Phone *

How can we help you? *

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