Pet Registration Form

Pet Registration Form

CLIENT INFORMATION
Thank you for giving Brentwood 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 Brentwood Veterinary Hospital please fill out the Client Registration Form and submit it as soon as possible at least 24 hours prior to your scheduled exam.
Primary Owner's Name*

First NameLast 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)*

MonthDayYear
Date
Has your pet(s) been seen by another veterinary hospital in the past? If so please provide veterinary records by email to bvh@brentwoodvet.net within 24 hours of submitting your New Client Application. We may need to reschedule your pets first appointment if we do not receive prior records on time. *
If yes, please list the hospital name, city and state
If your pet has been seen by another vet please enter that location's phone number
Please enter a valid phone number.
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 . Once you click the link, select the type of pet you have (cat or dog), then select "handout" to see a description of each level.
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*
Reason for exam.*
Are there any known allergies or significant information we should know about prior to your visit? If none please put N/A*
Person responsible financially*
Date*

MonthDayYear
Date
Should be Empty:

Pet Registration Form

PET INFORMATION