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New Client/Patient Registration Form
Bringing Compassionate and Experienced Care to Your Doorstep
Client Information
Primary Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Do You Consent to Texts (Staff Communication and Appointment Reminders Only)
*
Yes
No, Email Only
Address (please include gate code if necessary)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please indicate where we should park when we arrive.
Primary Email
*
example@example.com
Would you like to add a second person to your account? If yes, please type their name and relationship to you below. You may also include their phone number and email.
You have thoroughly read and understand our "Practice Policies" as detailed on the website: https://drwoofsveterinarycare.com/practice-policies
*
Yes
Pet Information
For their patient file, please upload a favorite photo of your pet.
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Pet's Name
*
Species
*
Please Select
Canine (dog)
Feline (cat)
Gender
*
Please Select
Male Intact
Male Neutered
Female Intact
Female Spayed
Breed
*
Color
*
Age/DOB (approximate if unknown)
*
How long have you had your pet?
*
Approximate Weight in Pounds
*
Is your pet microchipped? If so, please enter their microchip number.
Please upload your pet's medical records here or email them to drwoofsveterinarycare@gmail.com.
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Is your pet current on vaccinations? Please provide the dates they were/are due.
*
Has your pet ever had a vaccine reaction (mild or severe)? If yes, explain.
*
Has your pet ever traveled outside of Arizona? If yes, explain.
*
Please elaborate on the reason for your pet's visit. Does your pet have any pre-existing medical concerns of which we should be aware?
*
What is your pet's diet (main food, treats, table food), quantities, and frequency?
*
Is your pet currently taking any medications or supplements? If yes, please provide name, dosage, and frequency. This includes heartworm and flea/tick prevention.
*
Has your pet bitten anyone in the past? If yes, please explain.
*
How does your pet react to visitors to your home?
*
How can we make this visit better for you and your pet? Is there anything special you would like us to know about your pet?
May we use your pet's name and photos/videos on our social media?
Yes
No
How did you hear about us?
Please Select
Friend/Family
Referring Veterinarian
Internet Search
Social Media
NextDoor App
Review Site
Vehicle Decal
Other
By signing below you 1) give Dr. Woof's Veterinary Care and Dr. Holly Rice permission to treat your pet and 2) hold harmless Dr. Woof's Veterinary Care and Dr. Holly Rice from liability from any injury or illness you sustain while restraining your own pet.
*
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