New Client Form

New Client Registration
Pet Owner*

First NameLast Name
Co-owner/spouse

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone*
XXX-XXX-XXXX
Cell Phone
XXX-XXX-XXXX
E-mail
How did you hear about Hopewell Veterinary Hospital?

Family/FriendInternet search (Google, etc)Social Media (Facebook/Instagram)Sign out frontOther

New Patient Registration

Tell us about your pet
Patient name*
Patient species*

DogCatOther
Coat color/Breed/Other Description
Birthdate (if known)

MonthDayYear
Age
Specify years, months, etc
Sex

MaleFemaleUnsure
Is your pet spayed or neutered?

YesNo
Please upload your pet's records (vaccination and any previous medical records) here or bring them to the first appointment.

Browse Files

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We love pet pictures! Upload a picture of your pet to be used in their electronic medical record. (Optional)

Browse Files

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Financial Policy
Payment for for all charges is due at the time of service. Payment for hospitalization, boarding and surgery is due at the time the patient is picked up. Payment for all medications, food and other products is due at the time the items are picked up. Some special orders may require prepayment. Any returned checks will incur an additional fee. In the event that full payment is not recieved, the account may be referred to a collections agency. Hopewell Veterinary Hospital shall be entitled to collect all reasonable costs and expenses related to collections and/or lawsuit. This includes, but is not limited to reasonable attorney fees.
Signature*

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