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New Client Registration Form
Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.
Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.
Owner's Name
Prefix
*
Ms.
Miss.
Mrs.
Mr.
Mx.
Other:
If Other, Please let us know how you wish to be addressed:
Preferred Gender Pronoun
Name
*
First
Last
Address (Please also provide your apartment# if applicable)
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Mobile Phone
*
Landline Phone
*
Email
*
Enter Email
Confirm Email
Co-owner's Name & Contact #
Name
First
Last
Mobile Phone
Landline Phone
How did you find out about our practice?
Clinic Location / Sign
Personal Referral
Internet Search / Website
Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Have you booked your appointment?
*
Yes
No
If so, when is your appointment scheduled?
*
Date Format: MM slash DD slash YYYY
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Rabbit
Ferret
Bird
Reptile
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Sex
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinarian / Practice (if any)
Please bring your pet’s vaccination and any medical records to your first appointment
Please list any known/diagnosed allergies that your pet has
Has your pet ever experienced any ‘negative’ reaction(s) following vaccination?
Yes
No
If YES, please specify:
What does your pet eat? (brand)
What kind of treats do you offer your pet? (brands)
Is your pet taking any medication(s) or supplement(s)?
Yes
No
If YES, please specify:
Is your pet on regular flea, tick and/or heartworm prevention?
Yes
No
If YES, please specify:
We love sharing photos of our patients on Instagram, Facebook & other social media outlets. Do we have your permission to share your pet’s photo?
Yes, please tag me!
No, please DO NOT SHARE my pet’s photo publicly
What is your Instagram Handle @:
Please use the following box to give us any other relevant information about your pet
Book Appointment
New Clients
What to Expect
New Client Form
About Us
Meet the Team
Take A Tour
Location & Hours
Testimonials
Make an Appointment
Policies
Employment Opportunities
FAQs
Our New Friends
MY VET STORE
Services
Anesthesia and Patient Monitoring
Emergency Care
Hospice/Euthanasia
Laboratory
Medical Services
Nutritional Counseling
Pharmacy
Preventive Services
Surgical Services
Wellness and Vaccination Programs
Additional Services
Pet Health
Pet Health Library
How-To Videos
Pet Health Checker
Pet Insurance
News