New Client Form

Thank you for giving us the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following.

Name
First Last
Spouse's/Co-Owner's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Work Phone
Spouse/Co-Owner Phone
Email
How did you become aware of our clinic?
Who referred you?
Pet History
Pet #1
Name
Date
Date Format: MM slash DD slash YYYY
Type of Pet
Breed
Color
Sex
Pet #2
Name
Date
Date Format: MM slash DD slash YYYY
Type of Pet
Breed
Color
Sex
Consent*
AHC has my permission to take pictures of my pet; they may use for pets file, and can be posted to our websites and Facebook page.
Note: All patients are required to be up to date on Rabies and Distemper vaccinations.
Please let our staff know if you or any members of your family have food allergies. As a part of making your pet’s visit more enjoyable, we give many treats and wouldn’t want to make anyone sick! Please list allergies we should be aware of:

Pet feeling Blue? Try out our Pet Health Checker! Pet Health Checker

Pet History