The Hoof Vet New Client Registration

The Hoof Vet New Client Registration

Please complete this form to register yourself and your pet(s) with our veterinary practice.
Owner Full Name*

First NameLast Name
Address Where Animal is Located*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Animal's Name*

Barn NameShow Name
Species*
Breed
Pet Age (years)*
Pets Birthday if Known

MonthDayYear
Date
Sex*

GeldingStallionMare
Colors or Markings
Primary Discipline or Use
Insurance Company (if applicable)
Please include pertinent medical history and reason for appointment:
Photo, Video and Case Information Consent (please click all that apply):*

Educational Use Only: I allow photos, videos, or case information from my horse’s visit to be used for educational purposes such as lectures, webinars, articles, social media posts, or professional training (no identifiying information will be used)Case Discussion: I allow anonymous discussion of my horse’s case (without identifying information) for educational purposes.Medical Images: I allow medical images such as radiographs, hoof photos, or treatment progress photos to be used for educational examples.No Media Use: I do not consent to any photos, videos, or case information from my horse being used outside of the medical record.
Preferred Contact Method*

Phone CallText MessageEmail
Consent to Treatment, Communication and Payment Agreement*

Consent and Agreement: I authorize the veterinarian and staff to perform examinations, diagnostics, and treatments deemed necessary for the care of my horse(s) or dog/cat. I understand that while every effort will be made to provide the best possible care, veterinary medicine cannot guarantee outcomes.I consent to communication regarding my horse’s care via phone, text message, or email when appropriate. I also authorize the veterinary team to communicate with my horse’s farrier, trainer, or other members of my horse’s care team when it is beneficial for treatment and care coordination.I understand that this is a veterinary practice and agree that payment is due at the time services are rendered unless prior arrangements have been made. I accept responsibility for all charges related to the care and treatment of my horse(s).
Printed Name for Signiture*

First NameLast Name
Signature*
Today's Date*

MonthDayYear
Date
Should be Empty: