New Client Form

Pronouns:

Co-Owner Name (first & last):

Co-Owner Phone Number:

Pronouns:

Practice Name, City & State:

1. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

Female Intact

Female Spayed

Male Intact

Male Neutered

2. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

Female Intact

Female Spayed

Male Intact

Male Neutered

Would you like to receive Reminders via Email?

Yes

No

Would you like to receive Reminders via Text?

Yes

No

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I give permission to Spring Harbor Animal Hospital to post my pet’s picture to social media.

Yes

No

We often give your pets delicious treats while they are here; do any members of your household have any serious allergies such as a peanut allergy? If yes please specify:

New Client Form

Pronouns:

Co-Owner Name (first & last):

Co-Owner Phone Number:

Pronouns:

Patient Information:
We are happy to call your previous veterinarian to obtain a copy of your pet’s records. Please provide us with the following information.

Practice Name, City & State:

1. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

2. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

Pet Care Reminding Authorization

Would you like to receive Reminders via Email?

Would you like to receive Reminders via Text?

How did you hear about us?

If you were referred by a client, what is their name?

I give permission to Spring Harbor Animal Hospital to post my pet’s picture to social media.

Allergies:

We often give your pets delicious treats while they are here; do any members of your household have any serious allergies such as a peanut allergy? If yes please specify:

New Client Form

Pronouns:

Co-Owner Name (first & last):

Co-Owner Phone Number:

Pronouns:

Patient Information: We are happy to call your previous veterinarian to obtain a copy of your pet’s records. Please provide us with the following information.

Practice Name, City & State:

1. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

2. Pet's Name:

Age / DOB:

Species:

Breed:

Color:

Sex:

Pet Care Reminding Authorization

Would you like to receive Reminders via Email?

Would you like to receive Reminders via Text?

How did you hear about us?

If you were referred by a client, what is their name?

I give permission to Spring Harbor Animal Hospital to post my pet’s picture to social media.

Allergies:

We often give your pets delicious treats while they are here; do any members of your household have any serious allergies such as a peanut allergy? If yes please specify:

Patient Information:
We are happy to call your previous veterinarian to obtain a copy of your pet’s records. Please provide us with the following information.