New Patient Form - East Carolina Veterinary Service | Trusted Vet Clinic in Greenville, NC



2401 S. Charles Blvd. Greenville, NC 27858

Schedule An Appointment

Services
Client Resources
About Us
Online Store
Contact Us

New Patient Form

To reduce your wait time, and to give you more time with the doctors, please complete the following forms prior to your visit. If you have any questions about any of the information, don’t hesitate to call our offices. We will be happy to help.

Contact Information

Owner's Name

First Last

Spouse's Name

First Last

Email

Pet Name

First

Children's First Names

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Spouse's Work Phone

Employer

Job Title

Work Address

Spouse's Employer

Spouse's Job Title

Spouse's Work Address

Reminders are available for upcoming services. How would you like to be contacted?

US Postal Service to home address

E-mail address

Text

How did you first find out about us?

Yellow Pages

Hospital Sign

Website

Social Media

Personal Recommendation

Other

If you selected personal recommendation or other, please explain.

Please check all boxes below to indicate that you understand and agree with the following statements:

We will scan your pet for a microchip to verify chip information.

We will check your pet for external parasites (fleas, ticks, etc.) and treat accordingly at your cost.

We have permission to use your pet's phtoto on our website or other form of media.

I agree to pay for services rendered. All fees are due upon release of patient, unless other written payment arragements have been made.

Please indicate your chosen payment method

Cash

Check

Visa/MasterCard/Discover

Care Credit

In case of a major medical problem, who makes the final decision about treatment?

Veterinary and Pet Health Information

Is this your first pet?

Yes

No

How old was your pet when you first acquired it?

What's your pet's primary role in your life?

How many hours is your pet outside each day?

Would you like us to keep you informed about procedures to lengthen your pet's life?

Yes

No

Please list the names of any other pets in the household:

Name of previous veterinarian to contact for medical records:

Previous veterinarian's telephone number:

So that we are able to suit your individual needs - which do you feel most applies to you:

Check One:

I feel that my pet is another member of our family

I feel that my pet is just a pet

My pet is a working or show animal

Check One:

I want the best medical care available for my pet; please recommend anything that you feel is necessary for good health

I want good medical care for my pet, but there is a limit to what I am able to have done

I want to perform only the services that I request

Check One:

I want to learn as much as I can about pet health care, please explain in detail what has been done for my pet or what is needed

I would prefer that you just summaraize what has been done for my pet or what is needed

I want my pet healthy, but don't need to know what has been done

Check One:

I prefer to be present when my pet is examined and treated

I would rather not see my pet examined and treated

No opinion

Are any of the following a concern for your pet's behavior? Please check all that apply.

Excessive barking

Shedding

Straying from home

House breaking

Smell

Problems around children

Excessive itching/scratching

Jumping

Wetting/spraying in house

Does your pet travel out of state?

Yes

No

If so, which states?

Does your pet receive any supplements/additives to his/her routine diet?

Yes

No

If so, what type, how much, and how often?

Does your pet need more training?

Yes

No

If so, are you interested in learning how to improve your pet's maners?

Yes

No

How much exercise does your pet have each day, and what type of activity?

Is your pet aggressive towards people (bites, growls, snarls, bares teeth)?

Yes

No

If so, when and how often does your pet show aggression?

Does your cat/dog soil in the house or outside the litter box?

Yes

No

If so, give a brief description of what your pet does and how often

Does your pet escape from the yard?

Yes

No

Is your pet destructive in the house and/or yard?

Yes

No

Is your pet too active?

Yes

No

Does your pet vocalize too much (barks, howls, whines)?

Yes

No

Does your pet need too much attention?

Yes

No

Are you planning to add additional pets to your home?

Yes

No

What health care or grooming products are you currently using?

Consent

Checking this box serves as a digital signature, signifying that I have read and understood the above and have answered all questions to the best of my ability.

Schedule An Appointment

Click to access the Appointment Scheduling Form.

Location

East Carolina Veterinary Service

2401 S. Charles Blvd.
Greenville, NC 27858

Hours

Monday – Friday: 8am to 5:30pm

Saturday: 8am to 12pm

Contact Us

Tel: 252-355-4945

Fax: 252-355-0870

Email: ecvets@gmail.com

Emergency Info

If your pet has an emergency during normal business hours, please call us immediately for an appointment at (252) 355-4945.

For after-hours emergencies, contact Points East Veterinary Emergency Hospital of Greenville at (252) 321-1521 or Points East Veterinary Specialty Hospital at (252) 991-6560

Company

New Patient Form

Links

Appointments

Buy Meds & Food Online

© 2026 East Carolina Veterinary Service – All Rights Reserved. Powered by VisionPath Marketing. | Privacy Policy

Manage Consent

To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.

Functional Functional Always active

The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.

Preferences Preferences

The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.

Statistics Statistics

The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.

Marketing Marketing

The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

Manage options
Manage services
Manage {vendor_count} vendors
Read more about these purposes

View preferences

{title}
{title}
{title}

Manage Consent

To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.

Functional Functional Always active

The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.

Preferences Preferences

The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.

Statistics Statistics

The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.

Marketing Marketing

The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

Manage options
Manage services
Manage {vendor_count} vendors
Read more about these purposes

View preferences

{title}
{title}
{title}