New Client or Patient Application Form
Please fill out the form carefully.
Are you a current client or have ever been a client at the Delmar Animal Hospital?
*
Yes
No
Owner Name
*
Prefix
First Name
Last Name
Date of Birth (of human)
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Co-owner/Partner/Spouse
(if applicable)
Secondary Number
We are happy to have you with us! Which of the following options best describe why you are interested in becoming a new client with Delmar Animal Hospital? (Select all the apply)
*
New to the area and looking to establish care locally
New pet owner looking to establish care
Dissatisfied with current veterinarian
Current concern for pet's health (new illness or concern)
Second opinion or chronic concern for pet
I'm an established client with a new pet!
Other
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Pet Information
*
Pet Name
Date of Birth or Age
Pet Species
*
Please Select
Cat
Dog
Breed
*
Coat Color
*
Sex
*
Please Select
Male
Male - Neutered
Female
Female - Neutered
Unknown
Previous Vet Care
*
Please enter the name, number, and address of any veterinarian your pet has seen before. Please upload any records below. This allows us to personalize your pet's care and be sure we are not repeating vaccinations. However, we must have documentation from a veterinarian, breeder, or adoption record to include previous vaccinations in your pet's medical record.
Preferred Photo of Pet
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Previous Vet Records/Adoption Papers/Breeder Papers (attaching anything other than records from your pet's medical care may delay your registration)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Pet Care Commitment: I am willing to have my pet vaccinated, treated against parasites, and follow preventative care advice or advice on managing pain or illness should my pet get sick.
*
Yes. I want this care for my pet.
No. This isn't right for me and my pet.
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What to Expect at your First Appointment
From when you pull in to check out, we want you to know what to expect every step of the way!
When you schedule your appointment, the receptionist will ask you if you prefer
curbside
or
in-office
appointments. We will schedule you to fit your preference.
When you arrive in the parking lot, our coordinator will come out to your car to greet you and check you in.
No need to come to the door or call!
Once we let your assistant know that you are here, the doctor will get the room ready for you and your pet. There are times when
the doctor may be running behind
, but we will let you know if your wait time is expected to be more than 15 minutes past your appointment start time.
The assistant will come out and
escort you inside
with your pet (or just your pet, if you prefer).
Your first stop will be the scale if your pet is a dog. Otherwise, you'll go straight to the exam room --
No lobby necessary!
During your appointment, the doctor and their assistant will work
one-on-one
with you to examine your pet and apply any treatment you approve. The doctor will talk with you to discuss your pet's medical history and ask about concerns.
Together, you will make a care plan for your pet.
At the end of the appointment, the assistant and doctor will step out and collect any medications your pet is prescribed.
Please stay in the room so your assistant can find you!
The assistant will return with your products and the bill for the appointment.
Payment is expected at the end of the appointment.
We do not partner with insurance companies, so we are not able to process claims in the office. We do accept CareCredit, Visa, Mastercard, Discover, American Express, Cash, and Checks. Payment plans are not available at this time.
Depending on what your pet needs and the care plan you pick, your first visit may cost between
$75
and
$250
, with most being about
$150
.
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