New Client Registration Packet

WELCOME TO OUR PRACTICE!!

Thank you for giving us the opportunity to care for your pet(s). Please help us meet your needs by taking a moment to share some important information we will need to support your pet’s needs today and in the future.

A deposit for the first exam fee ($25.00) will be required to book your first appointment as this reduces no-shows and last-minute cancellations that impact our ability to care for current patients. This is a non-refundable deposit that may be transferred to a rescheduled appointment if reschedule is made 48 hours in advance. Future appointments do not currently require a deposit.

A staff member will reach out to you to schedule as soon as they’ve set you up in our system, usually the same business day.
To ensure proper registration with Brandermill Animal Hospital, please use the same name, address, phone number, and email address across all platforms. If you have any questions, please call or text us at (804)745-4243. Thank you!
Client Name*
Birthdate *

MonthDayYear
Date
Spouse/Other
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Names of all people, including family members who have permission to authorize care/treatment of your pet(s).
Emergency Contact
Did one of our clients refer you to us?

YesNo
If yes, who can we thank?
If no, how did you find us?
Pet Information:
Pet Name *
Pet Age *
Species*
Breed *
Sex*
Color*
Please list any additional pets by Name, Age, Species, Breed, Sex and Color: *
Do you have your pet's medical records? (Please note that we must receive medical history at least 48 hours prior to the appointment. If records are not received, we will contact you to reschedule the appointment.)*

YesNo
You may upload pet records here:

Cancelof
If no, please provide name and telephone number of previous veterinarian and we will request records on your behalf.
Any past medical problems or previous surgeries?
PAYMENT IS DUE AT THE TIME SERVICES ARE RENDERED. Due to Legal restrictions, Prescriptions cannot be returned. We accept Visa, MasterCard, Discover, American Express & CareCredit. There will be a$50.00 service fee for all returned checks. A finance charge on any outstandingbalance will be assessed at a minimum of $5.00 and/or 2% interest per monthafter 30 days. If necessary, a $50.00 collection fee will be applied, plus anycharges associated with collection of the outstanding balance.*

Clear
Printed Name*
Date*

MonthDayYear
Date
No Show/Cancellation Policy: We understand that you may sometimes need to reschedule appointments, however we require 24-hour notice for any changes to scheduled appointments. When you miss an appointment, it creates empty appointment slots for our doctors that cannot be used to serve other patients. This severely impacts our ability to care for the patients that need us. Please note that repeated missed appointments will result in a pre-paid deposit requirement for future appointments.*

I acknowledge this policy
Should be Empty:

To ensure proper registration with Brandermill Animal Hospital, please use the same name, address, phone number, and email address across all platforms. If you have any questions, please call or text us at (804)745-4243. Thank you!

Pet Information: