Eagle River Animal Hospital - New Patient Registration 2024

New Patient Registration
Name

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

MonthDayYear
Date
Age
Are you planning on breeding your pet?
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:
Pet's current medications (and dosages) and supplements:
I give my permission to use my pet's photo on ERAH website or Facebook page:
Signature
Date

MonthDayYear
Date
Where did your pet come from?
When?
State?
Where does your pet spend its time?
Where?
Where?
How often do you board your pet or take it to a groomer?
How often do you walk your pet in the neighborhood or a pet park?
What do you feed your pet?
Brand Name?
How Much?
Treats / Chews
How many?
Table food
Please verify that you are human
Should be Empty: