New Client Registration

New Client Registration

New Client Registration

Owner Information

Have you ever had a pet seen here before? If so, please notify a Customer Service Representative so they can recover your prior account. YesNo

Patient Information

Would you like a complimentary nutrition consultation?YesNo
Is your pet covered by a pet insurance plan?YesNo
Is your pet up to date on all vaccines?YesNo

Medical History

If you do not have copies of your pet’s medical history, is there a previous veterinarian we may call to request records?

For urgent care and emergencies, do you want records sent to another veterinary clinic? YesNo

Account Information

Fees are due at the time of services and upon release of patient.

Would you like patient email reminders? YesNo
Are you interested in pet insurance? YesNo
What is the best way to contact you? EmailPhone
Drivers license required for all check payments
How did you hear about our hospital?
Typing your full name acts as signature and gives Animal Health Services authorization to release copies of medical history when requested:
Typing your full name acts as signature and gives Animal Health Services authorization to take pictures of your pet for promotional purposed:
Typing your full name acts as signature and confirms that all information on this form is true to the best of your knowledge and that you will accept responsibility for any charges, fees or interest incurred on this account.