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New Patient Form

Please fill out our New Patient Form using one of the options below if your pet is a new patient at Northwest Veterinary Clinic of Mount Vernon.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Northwest Veterinary Clinic of Mount Vernon to release patient information to the primary care hospital or veterinarian.

Northwest Veterinary Clinic Client Agreement

By submitting this form, I hereby authorize Northwest Veterinary Clinic of Mount Vernon to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Northwest Veterinary Clinic of Mount Vernon.
Full payment at time of service. We accept Cash, Check, MasterCard, Visa, Discover, Debit, AMEX, Care Credit (Separate application required)
A fee of $50 will be applied to your account if an appointment is missed or if we are not given at least 24 hours notice of cancellation (48 hours notice required for surgical procedures).

New Patients Welcome

Northwest Veterinary Clinic of Mount Vernon is accepting new patients! Our vets are passionate about the health of Mount Vernon cats, dogs, and horses. Get in touch today to book your animal's first appointment.

Contact Us

(360) 424-4054 Contact