New client registration

Registration only; it does not request an appointment. To book a visit, request an appointment instead.

About you

Title (optional)

First name

Last name

Phone numbers

Add up to two numbers, name each one (for example, Cell, Work, or Home), and choose the best number to contact.

Phone name

Phone number

Primary contact number

Email (optional)

Partner title (optional)

Partner full name (optional)

Partner phone (optional)

Street address

Address line 2 (optional)

City

State

ZIP code

How did you hear about us?

Source (optional)

Emergency contact and medical decisions

Choose one branch. A contact who answers No may still be called in an emergency but cannot make medical decisions.

Emergency contact full name

Emergency contact phone

May this person make medical decisions for every pet?

Yes No

I do not authorize anyone else to make medical decisions for my pet(s)

Social media release

Your pets

Add every dog or cat you want included in this registration. Each pet remains a separate patient record.

Pet 1

Pet name

Species

Breed or mix

Date of birth or approximate age

Sex

Spay/neuter status

Color or identifying details (optional)

Current concerns (optional)

Current medications (optional)

Known allergies (optional)

Relevant medical history (optional)

This pet has records at another clinic

Staff will review your information before the first visit.

Do not include Social Security, driver’s-license, payment-card, or other government identification numbers.

New client registration

Pet 1

Review your registration

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