Complete Your Booking

Mon, Tues, Thurs: 7:30 AM – 7 PM
Mon: Closed 12 PM – 1 PM
Wed, Fri: 7:30 AM – 6 PM
Sat & Sun: Closed

Thank you for booking your appointment with Deer Grove Veterinary Clinic; we are excited to meet you and your pet soon! To complete your booking and ensure a smooth experience, please complete our new client intake form before you arrive so that we can familiarize our team with you, your pet, your pet’s medical history, and visit needs. This will ensure a quick check-in and productive visit.

If you have any questions or issues, please contact our team at Phone: (608) 839-5323.

New Client Deposit

New Client Intake Form

"*" indicates required fields

Owner Information

Client Account Number

Primary Phone Number*

Owner Name*

First Name Last Name

Work Number*

Cell Phone Number*

Co-Owner Name

First Last

Co-Owner Work Number

Co-Owner Cell Phone Number

Address*

Street Address Address Line 2 City State ZIP Code

Would you prefer reminders by POSTCARD or EMAIL?*

Postcard

Email Address*

Authorizations

TO WHOM CAN WE RELEASE RECORDS TO*

Wisconsin law requires written informed consent to release your pet’s health care records to certain third-parties (non-owners). Wis. Stat. § 453.075. Please indicate to whom you authorize us to release your pet’s health care records:

Other veterinary clinics / hospitals

Rescue / humane organizations

Property management organizations

Kennels / groomers / daycare / classes

How Did You Hear About Us?*

Please specify*

Promotion Code*

AUTHORIZED CARE*

Other than you and any additional owner listed above, are there any other persons to whom you give primary responsibility for the care of the patient(s) in the event that you are not able to be reached. Understand that the veterinarian will need to communicate with an owner of record, or someone designated by the owner, prior to treatment of the pet(s) in order to obtain informed consent. If you are not able to be reached, your pet(s) may not be able to receive care.

If you authorize an agent to obtain informed consent, please list the name for such other persons in the order you wish for us to contact them in the event that you or the co-owner(s) is not available.

ALL AUTHORIZED AGENTS MUST BE AT LEAST 18 YEARS OF AGE

Signature*

Phone

This field is for validation purposes and should be left unchanged.

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