New Client 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). If you have multiple pets, kindly fill out the form for each pet.



First Name:

Last Name:

Street Address:

Address Line 2:


State / Province / Region:

ZIP / Postal Code:


Day-Time Phone:

Evening Phone:

Mobile Phone:


Preferred method of contact:



First Name:

Last Name:




By clicking the Yes box below, you are consenting to receive text message communications from us if we need to make direct correspondence with you as our client (i.e. questions, appointment reminders, updates on food and medication orders, quick updates on our patients staying in the hospital). We will not use SMS communications for promotional uses. Msg & data rates may apply.


How did you find out about our practice?

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:




Pet's Name:


Breed (if known):


Date of Birth or Age (if known):

Special Identification (tattoo, microchip, etc.):


Insurance Company:

Policy Number:

Previous Veterinary Practice (if any):

Previous Veterinarian (if any):

Date of last vaccines (if known):

What vaccines were given at this time?

Is your pet on any medication or supplements?

If Yes, please list the medication or supplements:

What food does your pet eat?

Does your pet have allergies or drug reactions?

If Yes, please list the allergies and reactions:

Are there any current or past medical conditions of which we should be aware?

If Yes, please comment on the condition(s) and indicate if they are current or past conditions:

Please use the following box to give us any other relevant information about your pet:



Photos are added to your pet’s medical record and may be used in social media. If we were to take a picture of your pet, we would like your permission to use it in our social media content, promotional materials and/or publicity efforts. These photo may be used in publications, print ads, direct-mail pieces, electronic media (e.g. video, website) or other forms of promotion in perpetuity without remuneration or further consent. Your pet’s name may be shared, but your identifying information would not be.

I authorize the usage of my pet's photographs on social media.

If yes, want to be tagged in our posts? Provide us with your pet's Instagram account/username!