New Client Form | High Desert Animal Care Hospital

High Desert Animal Care Hospital offers our patient form(s) online so you can complete it in the convenience of your own home or office.

Please fill out the attached New Patient Registration form so that we can enter your information and your pets into our database. This will ensure that you are sent reminders, newsletters and keep you updated on your pet. Please bring this form with you to your first appointment to speed up the check-in process.

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"*" indicates required fields

Pet Owner Information

Owner's Name (Mr./Ms./Mrs./Miss)*:*

Address:**

Street Address* City* State* Zip Code*

Telephone:*

Cell**

Home

Work

Occupation

Employer

Driver's License #

Email Address(for reminders):

Secondary Owner's name:

Telephone

Cell

Home

Work

Occupation

Employer

Driver's License #

Pet Information

Pet's Name

Gender

Spayed/Neutered?

Birthday/Age

Breed

Color

Microchip?

VACCINATION & MEDICAL HISTORY: Please give dates of most recent services

Current Diet

Current Medications

Previous major medical/surgical problems & dates:

All payments are due at the time of services rendered. We accept cash, all major credit cards & Care Credit which can be approved in as little as 10 minutes. I have read and understand the above statements and agree to all terms therein.

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Name

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