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.

There is a review process for accepting new clients. Please fill out this form in it's entirety. We must receive all previous records before we review your pet's details. Appointments are NOT guaranteed. Once we review all details and records, if our review team accepts your medical request, a member of our team will reach out to you for scheduling. If your pet needs urgent care, please do not fill out this 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

Color a Pet

Total number of pets in household

Upload Medical Records

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

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. *

New Patient Registration Form

New Patient Registration Form

For Pet

Client Information

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