New Client Registration

New Client Registration

Welcome To Our Practice! Please complete the following information about you and your pet(s) accurately so that we may update your records. Thank you for choosing Highland Park Animal Hospital for your pet's care, we look forward to seeing you soon!
**Please complete this form only after your appointment has been scheduled with our staff**
Pet Owner Information
Pet Owner Name*

First NameLast Name
Primary Phone Number*

Area CodePhone Number
This number is my:
Alternate Contact

First NameLast Name
Phone Number

Area CodePhone Number
Pet Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Name & Address
Employer Phone Number

Area CodePhone Number
Email Address (Used for pet health reminders, appointment reminders, general communications)*
Email Address
Preferred Method Of Contact*

Home PhoneCell PhoneWork PhoneEmail

Please list any veterinary clinics that have previously cared for your pet. If not local, please provide city and state clinic is located in.
Are any of your pets on long-term medications or prescription diets? If so, please describe.
Has your pet ever had an adverse reaction to medication or vaccination? If so, please describe.

We Look Forward to Seeing You Soon!
If there is anything you'd like us to know about your pet before your appointment?
Would you like our staff to call you the day before your appointment as a reminder?

YesNoNo, but please text me to remind me
Should be Empty:

Pet Owner Information