New Client Registration Form

Primary Phone Number (Cell Preferred)(Required)

Secondary Phone Number

Email(Required)

This email will be the only address on your account. You will use this address to access our app and online pet portal. Download our app here! Once you verify the address on your account (in either the portal or app) you will have access to your pets' health records, vaccines, ability to order food and medications, and appointment scheduling.

If other, please specify:(Required)

If a current client referred you, please list their name here. (They receive loyalty rewards for referrals as a thank you!)(Required)

Pet's Name(Required)

Breed(Required)

Description (Color, markings, coat length, etc.)

Approximate Birthday

If other, please specify:(Required)

Upload a photo of your pet for their medical record!

Max. file size: 50 MB.

Previous / current medical records or other information:

Max. file size: 50 MB.

Authorization: I hereby authorize the veterinarian to examine, prescribe for, or treat, the above described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that payment is due at the time of release and that a deposit may be required for surgery and/or hospitalization.(Required)

Please fill out the information below for your pet's upcoming appointment. Providing detailed information will allow us to complete your check-in prior to your arrival at the hospital. You may also provide a preferred contact number specifically for today's appointment if it is different from your primary number. If you have any questions or concerns regarding your pet's appointment, please let a staff member know. We look forward to seeing you!

Best Phone Number for your Appointment(Required)

Date of Appointment(Required)

If other, please specify:(Required)

What current diet is your pet eating?(Required)

Please include the brand, life stage, and amount you are feeding daily.

If your pet is allergic to anything please list below:

Food, medications, anesthesia, previous reactions to vaccines, etc.

Please list all medications and supplements your pet is currently taking below. Include dosage, frequency, and the last time each medication was given. Be sure to include all preventative medications as well (flea/tick/heartworm/intestinal parasites, etc.).

If other, please specify:(Required)

Please include any additional information you would like Dr. Miller and our staff to know prior to your pet's appointment. We all look forward to meeting you and providing care for your pet!

Provide Your Information

Complete Your Registration Form

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