Countryside Animal Hospital blue and gold outdoor sign featuring images of dogs and cats.



New Client Form

Welcome to the Countryside Animal Hospital family! To help us prepare for your first visit, please complete the New Client Form ahead of time. This form lets us get to know you and your pet, so we can provide personalized care right from the start.

Get Started



New Client Form at Countryside Animal Hospital

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

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

First

Last

Phone

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

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Do you have a second pet? *

Pet's the credit.

Payment is due in full at the time that services are performed. We accept cash, all major credit cards, debit cards payments and care credit. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Name

New Client Form

New Client Form at Countryside Animal Hospital

Caring for the Pets of Waupaca, Wisconsin, and the Communities Around Us

Have a Question?

Location

Contact Information

Hours