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718-888-0400

22-22 154th Street,
Whitestone, NY 11357

Pet Emergency at Whitestone Veterinary Care Visit our sister hospital in Long Island

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Home • New Client Form

Welcome New Clients! New Client Form

Please do not use this form if your pet is experiencing an emergency. If your pet is experiencing an emergency call us right away at 718-888-0400 and we will prepare for your arrival.

CLIENT INFORMATION:

Your First Name [*] Required Field

Your Last Name [*] Required Field

Address [*] Required Field

City [*] Required Field

State [*] Required Field

Zip [*] Required Field

Home Phone

Cell Phone [*] Required Field

Work Phone

Email Address [*] Required Field (We can email exam report cards and important notices.)

Spouse’s Name

Spouse Cell

Spouse Work

Preferred Contact Method?

Cell Phone Service Provider

How did you hear about us?

Other (please name)


FINANCIAL INFORMATION

Credit Card

I have Pet Health Insurance

I do not have Pet Health Insurance (Please tell me about it!)

I hereby authorize the doctors and staff to diagnose, prescribe for, and treat the above described pet. I assume all responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time services are rendered. In the case of hospitalization, I will be required to leave a substantial deposit. The remaining balance must be paid in full at the time of discharge of the pet. I authorize photos and video to be taken of my pet’s care for training, website, and educational purposes.

Please present a valid drivers license or photo id at the time of check-in.


PET INFORMATION

Pet Name

Birth date/Approx age

Type of Pet?

Breed

Color

Sex

Neutered/Spayed

Indoor/Outdoor

Is your pet Microchipped?

Where did you get your pet?

When did you get your pet?

Approx. age when acquired

Past Veterinarian

Would you like us to contact past vet for medical history?

Approx. date of last veterinary examination

Last vaccinations (date)

How many, and what type of pets do you own?

Dog(s)

Cat(s)

Bird(s)

Other (specify)

Kindly list any previous medical or surgical problems and current medications

Is your pet current taking Heartworm Preventative?

Name of Meds

What flea and tick protection are you currently using on your pet(s)

What brand of food is you pet currently eating

How much do you feed daily

Does your pet get any table scraps and how often

Describe your pet’s temperament (personality)

Reason for visit

The individuals listed below are authorized representatives to act on your behalf in cases dealing with the pet listed above. They are authorized to obtain medical information regarding your pet, to admit and pick up your pet from our facility, and give verbal and/or written authorization to perform medical services and procedures. The individuals listed below are required to show photo identification when acting as your authorized representative.

Authorized representative #1 (include name, relatinship and contact number)

Authorized representative #2 (include name, relatinship and contact number)

Authorized representative #3 (include name, relatinship and contact number)


  • Whitestone, Flushing, Queens, Little Neck, Great Neck and Bayside NY
  • I am extremely satisfied with Whitestone Veterinary. I have been with them for 6 years & have two dogs in their care. They are very thorough & caring. After I bring my dogs in for a shot or illness they always call the next day to ask how the dogs are. I highly recommend them & have recommended them.
  • Dr. Wyler and his team are caring, patient, knowledgeable and sensitive! Have been bringing our pets here for many years and have always received top quality, thorough care by experts who love animals. If there were more than 5 stars, I'd give more!
  • Absolutely love this place Dr. Wyler and all of the veterinarians and assistants have been taking care of my dog for 10+ years and they are very patient with the animals and owners. I appreciate everything they have done for my dog. This is the place to go for your animals I recommend it 1 milliom percent! The Hempstead location is the exact same way!

HOURS OF OPERATION:
Mon: 9am - 8pm
Tue, Wed, Thu, Fri: 9am - 6pm
Sat: 9am - 4pm


DOCTOR ON CALL UNTIL 11PM

VETERINARY SERVICES

Veterinary Services at Whitestone Veterinary Care

DISCOUNTS & PROMOTIONS

Veterinary Promotions at Whitestone Veterinary Care

FREE VACCINES FOR LIFE

Free Vaccines For Life

CARE TO SHARE PROGRAM

Care to Share Program