Eagle River Animal Hospital - New Patient Registration 2024

New Patient Registration
Name*

First NameLast Name
Email*
example@example.com
Pet's Name*
DogCatOther
Breed*
Color*
Microchip #
MaleNeuteredFemaleSpayed
Date of Birth

MonthDayYear
Date
Age
Are you planning on breeding your pet?*

YesNo
When was your pet(s)' last vaccine visit? *
If you are visiting this office for the first time, it is important that we receive all prior, and appropriate medical history for your pet. This information could provide useful history in order to properly treat your animal. It is recommended that you contact your previous veterinarian(s) and have this information faxed or emailed to our office.

Our office fax number is 715-479-5083 and our email is: info@eaglerivervet.com
Previous animal hospital(s) where pet was seen
Describe any previous illnesses, behavior problems, or surgeries your pet has had:
None
Pet's current medications (and dosages) and supplements:
None
I give my permission to use my pet's photo on ERAH website or Facebook page:*

YESNO
Signature*

Clear
Date*

MonthDayYear
Date
Where did your pet come from?*

StrayShelterPrivate HomeBreederRescue organization
When?
State?
Where does your pet spend its time?

Indoors onlyIndoors mostly and on leash/in fenced yard sometimesIndoors sometimes and outdoors on own sometimesOutdoors onlyHuntsRegularly travels out of region/state
Where?
Where?
How often do you board your pet or take it to a groomer?

NeverOnce a year or less2 - 3 times a year4 or more times a year
How often do you walk your pet in the neighborhood or a pet park?

NeverOnce a week or less2 - 5 times a weekDaily
What do you feed your pet?

DryCanned
Brand Name?
How Much?
Treats / Chews
How many?
Table food
Please verify that you are human*
Should be Empty: