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(252) 291-5270
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New Client Form

Thank you for giving Wilson Veterinary Hospital the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following.

Client Information

Email Address

Name

First Last

Spouse's Name

First Last

Mailing Address

Street Address Address Line 2 City State ZIP

Home Phone

Cell Phone

Spouse's Phone

Employer

Emergency Contact

First Last

Emergency Contact Phone

All fees are due at the time services are rendered. We accept cash, check, debit, Visa MasterCard, Discover and CareCredit.

How did you become aware of our clinic?

Friend/Relative

Drove by

Internet

Previous Client

Other

Personal Recommendation - whom may we thank?

Please describe how you found us:

Patient Information

Pet #1

Name

Species

Breed

Color

Sex

Male

Female

Spayed/Neutered

Yes

Date of Birth

Previous serious illness or surgeries?

Allergies to vaccinations/medications?

Is your pet on any special diets or medications?

Pet #2

Name

Species

Breed

Color

Sex

Male

Female

Spayed/Neutered

Yes

Date of Birth

Previous serious illness or surgeries?

Allergies to vaccinations/medications?

Is your pet on any special diets or medications?

Wilson Veterinary Hospital

4741 Lake Wilson Rd
Elm City, NC 27822
Phone: (252) 291-5270
Fax: (252) 291-6076
Email: wilsonvet@thevetspets.com

Hospital Hours

Monday – Friday 7:30 am – 6:00 pm
Saturday 7:30 am – 12:00 pm
Sunday Closed

After-Hours Emergency Services

Points East Veterinary Specialty Hospital

5702 Grover Lane
Sims, NC 27880
(252) 991-6560

Wake Veterinary Hospital & Urgent Care

1007 Tandal Pl, Knightdale, NC 27545
(919) 266-9852

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