For your convenience

New Client Form

Name: Country View Veterinary Hospital
Address: 582 Pacific Dr American, Fork, UT, 84003, United States
Telephone: 801-763-1900
Price range: $

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 801-763-1900 for a faster response.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Email *

Preferred Method of Contact *

Email
Phone
Postal Mail

Spouse/Co-Owner Name

First

Last

Spouse/Co-Owner Phone

How did you learn about our clinic? *

Sign outside
Facebook
Website
Recommendation
News Paper
Other

Other

If recommended, by whom?

Number of Dogs

Number of Cats

Other (specify)

Reason for visit:

Pet Health History

Pet's Name *

Species *

Dog
Cat
Other

Please specify

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Vaccination History (date & type of last vaccination)

Pet's current medication:

Describe your pet's diet:

Authorization

I give permission for Country View Veterinary Hospital to share photographs or case specific information about my pet in all media (including promotion, advertising, sale, publicizing, and general marketing of Country View Veterinary Hospital). *

I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet. I assume full responsibility for all charges incurred for the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

Signature *

Date *

Name

Ready for a visit?

We proudly serve the pets of American Fork, Lehi, Saratoga Springs, Salt Lake City, and surrounding areas. We look forward to seeing you and your pet! Download our PetDesk app or request an appointment by clicking the buttons below.

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Find Us

582 Pacific Dr
American Fork, UT 84003

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Contact Us

P: 801-763-1900
F: 801-492-3519
E: [email protected]

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Hours

Mon–Thurs: 7:00 am to 6:00 pm
Fri: 7:30 am to 6:00 pm
Closed Sat & Sun

Yes! We accept walk-ins

We will do our best to accommodate your pet if an urgent matter arises during business hours.

Have a question?

Let’s get in touch! Fill out our contact form and a member of our team will be in touch during walk-in hours. If you need immediate assistance, please feel free to call us.

Name *

First

Last

Email *

Phone

How can we help you? *

Name