New Patient Registration Form

Save time during your next appointment! Complete your required new patient registration form online from any device at any time before your visit.

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New Patient Registration Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.
OR
You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Please bring the completed PDF form for your pet’s first appointment.

Download Form

For Pet

Pet's Name *

Species *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Age/Date of Birth *

Client Information

Owner’s Name *

First

Last

Address (physical & mailing) *

Address Line 1

Address Line 2

City

State

Zip Code

Email Address *

Main Telephone *

Secondary Telephone

Place of work

Phone

The following people and only these people may act as my agent

Phone

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid for at the time of release and that a deposit may be required for surgical or complicated treatments in advance of service. *

I have read and agree

I Grant New River Animal Hospital Permission To Post My Pet’s Picture, Story, And Medical Information On Social Media. *

Yes
No

Message

New Patient Registration Form

New Patient Registration Form

For Pet

Client Information

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