New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooporation in letting us assist you.

    New Client

    First Name (required)

    Last Name (required)

    Spouse or Partner

    First Name

    Last Name

    Children's Names/Ages

    Address (required)

    Street Address (required)

    City (required)

    State / Province (required)

    Zip / Postal Code (required)

    Your Email (required)

    Home Phone (required)

    Phone Type

    Cell Phone

    Phone Type

    May we text you (reminders/prescriptions are ready, ect.)?

    Work Phone

    Phone Type

    Place of Employment

    May we contact you at work?

    Best time/phone # to call regarding your pet's care:

    Spouse/Partner Work Phone

    Phone Type

    Spouse/Partner Place of Emloyment

    May we conact your spouse/partner at work?

    Emergency Contact

    First Name

    Last Name

    Emergency Contact Phone #:

    How did you first hear about us? (required)

    Personal referral-friend/relativeyellow pagescivic group or community eventnewspaper adradio adnew resident programdirect mail or couponinternet adpet store or humane societysign,location,drove byour website (

    If you first heard of us from a personal referral please let us know who to send a Thank You to!

    Why did you decide to come here? (required)

    AAHA Accreditation! Ask us if you don't know about AAHAExtended convenient hoursSunday hours for pickup and admitting (pet accommodations only)Overnight pet care M-F for hospitalized and healthy petsConvenient LocationPick Up and Delivery OptionsWe do housecallsReferral/Reputation in the communityLodging Facilities for dogs, cats (separate!), exotic petsPerson who answered the phone was friendly/competentLaser Surgery availablePain Management Services-Therapy laser, massage...Veterinary Care for Exotics (birds,reptiles,rodents etc)

    How do you view your pet(s) in terms of overall health concerns/issues?

    As a family member (I am concerned about all health issues and recommendations)As a pet (only concerned with basic health care such as exam and vaccinations)

    Pet's Name (required)

    Date of Birth

    Type of Pet (required)


    Breed: (required)

    Sex: (required)




    Pet's color/markings (required)

    Date of pet's last examination

    Please list all other pets below. Please include sex, if they are altered, breed and age.

    Medical records at another veterinary Practice?


    Name of Former Veterinary Practice

    May we request a transfer of records?


    Would you like us to call you for your appointment


    Reasons or conditions that prompted your visit?

    Special requests or conditions?

    May we use your pet(s) picture(s) on our website and other materials (bulletin boards etc)? (required)


    Please Read
    I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Companions Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly service charge of 2% and a $6 handling fee. Any balance that I leave unpaid will be forwarded to Companions Animal Hospital's collection agency, and will incur a $35 collection fee for which I am liable, in addition to monthly finance charges.

    I have read this statement and (required)

    I AgreeI Disagree


    Check to confirm submission.