Forms

New Client Form

Thank you for choosing Terrace Heights Family Pet Clinic as your preferred Yakima, WA veterinarian! Please fill out the following form before your scheduled appointment.

Get Started

Welcome New Clients!

We are glad to have the opportunity to care for your pet. To ensure your pet gets the best care we can offer, please fill out the following form completely. Please Note: All * fields are required.

Do you have an appointment scheduled? If so, what is the date and time?

Date

Time

Name *

First

Last

Spouse/Other *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Employer name and address

Spouse/Employer's Phone Number

If necessary, can we call you at work?

Describe other animals in household

Email *

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

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Sex *

Male
Neutered Male
Female
Spayed Female

Breed *

Color *

Vaccination History

Date and type of last vaccination

Where was the vaccination given?

Please check any symptoms or problems that you have noticed about your pet

Behavior Problems
Bleeding Gums
Breathing Problems
Coughing
Diarrhea
Eye Bulging or Bloodshot
Gagging
Lack of Appetite
Limping
Loss of Balance
Scooting
Scratching
Seems Depressed
Shaking Head
Sneezing
Thirst and/or Urination Increased
Vomiting
Weakness
Weight Problems
Other

Please describe

Current Medications, if any

Describe your pet's diet

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in 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. *

Clear Signature

Date *

Method Of Payment (Required) *

Cash
MasterCard
VISA
Care Credit
Debit
American Express
Discover

I have read the payment policy *

Website

Ready for a visit?

We proudly bring lifelong wellness to the pets of Yakima, Pomona, Selah, Moxee, Wapato, Union Gap, Ahtanum, and beyond. Easily request an appointment for your pet using our online system!

Book Appointment

Have a question?

Get in touch! Complete our online form, and a member of our team will be in touch with you shortly. If you’re in need of immediate assistance, please contact us at 509-452-1262.

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Find Us

721 N Keys Rd
Yakima, WA 98901

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Our Hours

Mon–Fri: 7:30 AM – 5:30 PM
Sat Closed
Sun Closed

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Contact Us

509-452-1262
Thpetclinic721@gmail.com

Name *

First

Last

Email *

Phone

How can we help you? *

Name