Mon: 7:30 AM – 8:00 PM
Tue – Fri: 7:30 AM – 6:00 PM
Sat: 8:00 AM – 1:00 PM

425-485-6575
6630 NE 181st St. Suite F103,
Kenmore, WA 98028-4852

New Client Form

  • Client Information

  • Pet Information

  • Dog Vaccines

    For dogs, please confirm which vaccines are current for your pet.
  • Cat Vaccines

    For cats, please confirm which vaccines are current for your pet.
  • Pet Medical History

  • Authorization

  • I grant to Kenmore Veterinary Hospital, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Kenmore Veterinary Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including but not limited to publicity, illustration, advertising, and web content.
  • I, the undersigned, do hereby certify that I am the owner, or assuming responsibility, financial or otherwise, for the animal being presented to Kenmore Veterinary Hospital for the treatment of care. I hereby consent and authorize Kenmore Veterinary Hospital to receive, prescribe for or treat, as indicated, this animal presented. It is thoroughly understood that I assume all risks. I agree, if appropriate, to pick up this animal at the designated date and time agreed to by myself and Kenmore Veterinary Hospital. If in the event that the animal is not picked up, there will be a notice of 10-days to come claim the animal or it will be considered abandoned. The animal will be held in the manner that is considered to be most appropriate for the animal and the hospital. It is understood that I am not released from costs associated with the care of the pet. We do not bill and all fees are due when services are rendered. Deposits are required for all hospitalized patients. Our Hospital only accepts cash, personal checks (driver’s license required), Visa/MasterCard, American Express, Discover Card, Scratchpay, and Care Credit. I understand that if I do not pay my balance in full, that I am responsible for all statement fees, finance charges, and attorney/collection fees.
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