New Client Registration Form

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Pet Owner

Confirm Email

Daytime Phone

Home Phone

Work Phone

Secondary Contact

Daytime Phone

Mailing Address

City

State

ZIP / Postal Code

Pet's Name

Date of Birth (if known)

Species

Sex

Breed

Color, Markings, and Identification (microchipping, etc)

Specify any past health medical conditions, concerns about your pet's current health, and any known allergies or drug reactions.

List any preventives, medications, or supplements you provide your pet.

Please describe your pet's diet to include brand of food and the quantity and frequency of feeding.

Has your pet been treated for illness in the past year?

Yes No

Previous Veterinarian(s) where past records could be obtained:

How did you hear about us?

Who should we thank for referring you to us?

I grant consent for Tri-County Veterinary Clinic to use my pet(s)' image for marketing or promotional material, either digital or print.

Yes No

I assume responsibility for all charges incurred in the care of this animal. I also understand these charges will be paid at the time of service or release and that deposit may be required for surgical treatment.

I agree to the Terms & Conditions

New Client Registration Form

Save $50 on Your Pet’s Next Visit