Pet Registration Form

Pet Registration - Four Corners Veterinary Hospital

Updated 1.2022
Thank you for giving Four Corners Veterinary Hospital the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following:

New Clients: If you are new to Four Corners Veterinary Hospital please fill out the Client Registration Form (If this is for a puppy, also complete the New Puppy Form) and submit it as soon as possible. Once we receive your form(s) one of our Client Service Representatives will call you within 72 hours to schedule your first appointment.

New client appointments can not be booked until we receive the completed form(s).
Client # (To be completed by hospital personnel)
Primary Owner's Name *

First Name Last Name
Primary Owner's Email *
example@example.com
Owner's Main Phone *
Please enter a valid phone number.
PET INFORMATION

Please complete a separate form for each pet
Pet's Name *
Pet's DOB (approximate if unknown) *

Month Day Year
Date
Has your pet(s) been seen by another veterinary hospital in the past? If so please provide veterinary records by email to fourcornersvet@outlook.com or fax at 925-685-7152 within 24 hours of submitting your New Client Application. First appointments will not be scheduled without prior records *
If yes, please list the Hospital Name, City and State. *
On a scale of 1-5 (5 being the most fearful), how fearful is your pet when visiting a Veterinarian. To understand the rating scale please click the Fear Free Logo below to access the FAS Guide *
Does your pet(s) take or need any Pre Visit Pharmaceuticals to relax him/her prior to a veterinary visit? If your pet has taken such medications please list medications and dosage. If your pet does not take any Pre Visit Pharmaceuticals please list N/A. *
Species *
Breed *
Color *
Pet's Gender *
Pet Spayed/Neutered *
Does your pet need an appointment in the next 6 weeks? *
Reason for appointment if needed within 6 weeks. If no appointment is needed please put N/A *
Are there any known allergies or significant information we should know about prior to your visit? If none please put N/A *
Please list the last known Vaccination information below
Vaccination
Date

Month Day Year
Vaccination
Date

Month Day Year
Vaccination
Date

Month Day Year
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Pet Registration - Four Corners Veterinary Hospital

PET INFORMATION