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Now Open & Accepting New Clients!

New Client Welcome Information Vaccine Policy

Stonewater Veterinary Hospital

New Patient Form

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New Patient Form

Today's Date *

Owner's Name *

First

Last

Additional Contact

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

Email *

Employer

Work Phone

Additional Contact Employer

Additional Contact Work Phone

Who can we thank for referring you to this hospital?

PAYMENT IS EXPECTED AT TIME OF SERVICES.

Pet Information

Species *

Dog
Cat

Pet's Name *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Any major surgeries we should know about?

If yes, please provide procedure, date and any other details.

Any chronic problems we should know about?

Is your pet taking any continual medication?

Approximate date of last canine distemper/parvo vaccine *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last canine leptospirosis vaccine *

Approximate date of last canine bordetella vaccine *

Approximate date of last feline FVRCP immunization *

Approximate date of last feline leukemia immunization *

Approximate date of last feline leukemia/FIV test *

Approximate date of last rabies immunization *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last heartworm check *

Please list any other immunizations your pet has received

Anything else you would like us to know?

Would you like to add a second pet? *

Yes
No

Second Pet Information

Species *

Dog
Cat

Pet's Name *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Any major surgeries we should know about?

If yes, please provide procedure, date and any other details.

Any chronic problems we should know about?

Is your pet taking any continual medication?

Approximate date of last canine distemper/parvo vaccine *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last canine leptospirosis vaccine *

Approximate date of last canine bordetella vaccine *

Approximate date of last feline FVRCP immunization *

Approximate date of last feline leukemia immunization *

Approximate date of last rabies immunization *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last heartworm check *

Please list any other immunizations your pet has received

Anything else you would like us to know?

Would you like to add a third pet? *

Yes
No

Third Pet Information

Species *

Dog
Cat

Pet's Name *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Any major surgeries we should know about?

If yes, please provide procedure, date and any other details.

Any chronic problems we should know about?

Is your pet taking any continual medication?

Approximate date of last canine distemper/parvo vaccine *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last canine leptospirosis vaccine *

Approximate date of last canine bordetella vaccine *

Approximate date of last feline FVRCP immunization *

Approximate date of last feline leukemia immunization *

Approximate date of last rabies immunization *

Is this vaccine: *

1-year dose
3-year dose

Approximate date of last heartworm check *

Please list any other immunizations your pet has received

Anything else you would like us to know?

Medical Records

Previous Veterinary Record(s)

Click or drag files to this area to upload. You can upload up to 15 files.

Please upload any medical history you may have from your previous veterinarian(s).

Have a question?

Contact Stonewater Veterinary Hospital

Let’s get in touch! Stonewater Veterinary Hospital proudly serves the communities of Clayton, Garner, Smithfield, Raleigh, Fuquay-Varina and beyond.

Contact Us

Get in touch

Our team is here to help. Please contact us using one of the methods below if you have any questions.



Address

8810 US Hwy 70 Bus W, Clayton NC 27520

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Contact Information

P: 919-589-8515
F: 919-589-8514
E: [email protected]

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Hospital Hours

Mon: 7:30am – 5pm
Tue: 7:30am – 5pm
Wed: 7:30am – 5pm
Thu: 7:30am – 5pm
Fri: 7:30am – 5pm
Sat & Sun: Closed

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Last

Email *

Phone

How can we help you? *

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