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(253) 536-3633

Services
Hours & Location
About Us
Contact

(253) 536-3633

Services
Hours & Location
About Us
Contact

New Client Form

Welcome to Canyon Road Veterinary Hospital. The following information will help us to serve you better. Please complete this form only after having confirmed your appointment with us over the phone.

Co-Owner Name (first & last):

Co-Owner Phone Number:

Patient Information:

Pet's Name

Age / DOB

Species

Breed

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Reason for your pet's visit:

Canyon Road Veterinary Hospital

15114 Canyon Rd E
Puyallup, WA 98375

phone: (253) 536-3633
fax: (253) 531-7511 • email us

Veterinarians serving the Puyallup, WA area, including (but not limited to): Graham, Roy, Tacoma, Spanaway, Bonney Lake, South Hill, Fredrickson, and Lakewood.

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