Client Form & Links

Whether you’re looking to visit our hospital in Moline for the first time or would like to access our online store, we have the resources you need right here. Can’t find what you’re looking for? Give us a call at (309) 524-5696!

New Client Form

If you’re planning your pet’s first visit to our animal hospital, we invite you to fill out our New Client form so you can spend less time on paperwork when you arrive. Just fill out all of the required fields, let us know how you heard about City Line Veterinary Center, and click the ‘Submit’ button when you’re done.

Client's Name(Required)

First Last

Secondary Name on Account

First Last

Address(Required)

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

Phone(Required)

Email(Required)

Secondary Phone

Pet's Name(Required)

Species(Required)

Breed(Required)

Color(Required)

Date of Birth/Estimated Age(Required)

Please select one:(Required)

Male

Neutered Male

Female

Spayed Female

Please list any known allergies or medical conditions:

Referral Source

Vaccine History

If vaccine history is not available, can we contact your previous vet?(Required)

Yes

How did you hear about City Line?(Required)

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

View Your Pet’s Medical Records

See your pet’s full health history and keep up with appointment reminders using your Petly account.

Shop Online

Click the button below to visit our online store where you can purchase affordable, quality food and parasite prevention products for your pet. All items can be shipped directly to your doorstep!

Client Form & Links

New Client Form

View Your Pet’s Medical Records

Shop Online

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