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.