Skip to content
Home
Our Hospital
Our Team
Careers
Hospital Tour
Services
Pet Wellness Exams
Vaccinations
Dental Care
Surgery
Diagnostics
New Clients
Payment Options
Forms
Contact Us
Make An Appointment
Home
»
New Patient Registration
New Patient Registration
New Patient Registration
Step
1
of
5
20%
Client Details
Name
(Required)
First
Last
Spouse Name
First
Last
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Primary Phone Number
(Required)
Home Phone Number
Work Phone Number
Spouse's Cell Phone Number
Spouse's Work Phone Number
Email
(Required)
How may we contact you with updates and reminders?
(Required)
Phone
Text Message
Email
Pet #1
Name
(Required)
Date of Birth (Approx.)
Breed
(Required)
Color
(Required)
Species
(Required)
Canine
Feline
Exotic
Sex
(Required)
Male
Neutered Male
Female
Spayed Female
Any previous health concerns?
(Required)
Pet #2
If you do not have any other pets to add, please just skip this page.
Name
Date of Birth (Approx.)
Breed
Color
Species
Canine
Feline
Exotic
Sex
Male
Neutered Male
Female
Spayed Female
Any previous health concerns?
Pet #3
If you do not have any other pets to add, please just skip this page.
Name
Date of Birth (Approx.)
Breed
Color
Species
Canine
Feline
Exotic
Sex
Male
Neutered Male
Female
Spayed Female
Any previous health concerns?
May we contact your previous vet to obtain:
(Required)
Vaccination History
Medical Records
Don’t Contact
Hospital Name / Location
Hospital Number
Hospital Email
Please upload any previous records for your pets here.
Max. file size: 50 MB.
May we post photos of your pet on our website, social media, and/or other internal marketing?
(Required)
Yes
No
How did you learn about our hospital?
(Required)
Personal Referral
Website
Facebook
Internet / Google
Signage
Other
If you were referred, whom may we thank?
(Required)
If Other, please explain:
(Required)
Consent
(Required)
I agree
I hereby authorize All Dogs and Cats Veterinary Hospital to examine, provide services, prescribe medication and/ or treat the animal described above. I understand that a deposit may be required prior to any major medical treatment or surgical procedure. I agree that all charges shall be paid in full at the time of service and that I will be held personally responsible for those incurred charges. In the unlikely event that my account becomes delinquent and is referred to collections, I understand that I will be charged interest at a rate of 1.5% per month. Any account referred to collections may also have an amount assessed up to 40% of the principal balance as dictated by State and local regulations. I further understand that I could be liable for reasonable attorney fees and court costs should legal action be taken in the attempt to collect on the debt. By signing below, I attest that I am at least 18 years of age and agree to these conditions.
Signature
(Required)
Reset signature
Signature locked. Reset to sign again
CAPTCHA
Find Us
Make an Appointment
Online Pharmacy
What's Next
1
Call us or schedule an appointment online.
2
Meet with a doctor for an initial exam.
3
Put a plan together for your pet.
Make An Appointment