Highland Animal Hospital

New Client Form

Thank you for choosing Highland Animal Hospital. Please fill out our new client form below before your first appointment with us! We look forward to meeting you!

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New Client Form

Thank you for giving us the opportunity to care for pet. Please help us better meet your needs by taking a few moments to complete this information form. If you would prefer to download our form to print and fill out at home, please click the button below.

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Date(Required)

MM slash DD slash YYYY

Owner's Name(Required)

First Last

Owner's Date of Birth(Required)

Spouse/Other

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Primary Phone(Required)

Is this your:(Required)

Home Number

Work Number

Cell Number

Secondary Phone

Is this your:

Home Number

Work Number

Cell Number

Additional Phone

Is this your:

Home Number

Work Number

Cell Number

Spouse's Phone

Driver's License #

Place of Employment(Required)

Spouse's Employer

Is it best to call you:

At home

At work

On your cell

At what time?

In case of EMERGENCY please call(Required)

First Last

Phone(Required)

We will gladly prepare a written estimate if you so desire. Please ask a receptionist or doctor.

Professional fees are due at time services are rendered. Preferred method of payment:(Required)

Cash

Check

Debit Card

Credit Card

Animal Medical History

Name of Previous/Current Veterinarian

Address

Street Address Address Line 2 City State ZIP Code

Pet's Name(Required)

Species(Required)

Dog

Cat

Other

If other, please specify(Required)

Breed(Required)

Color/Markings(Required)

Pet's Age/Date of Birth(Required)

Sex

Male

Male (neutered)

Female

Female (spayed)

Diet (name of your pet's food)(Required)

Daily medications, vitamins, or treats(Required)

Do you have another pet to add?(Required)

Yes

Second Pet Information

Pet's Name(Required)

Species(Required)

Dog

Cat

Other

If other, please specify(Required)

Breed(Required)

Color/Markings(Required)

Age/Date of Birth(Required)

Sex

Male

Male (neutered)

Female

Female (spayed)

Diet (name of your pet's food)(Required)

Daily medications, vitamins, or treats(Required)

Do you have another pet to add?(Required)

Yes

Third Pet Information

Pet's Name(Required)

Species(Required)

Dog

Cat

Other

If other, please specify(Required)

Breed(Required)

Color/Markings(Required)

Age/Date of Birth(Required)

Sex

Male

Male (neutered)

Female

Female (spayed)

Diet (name of your pet's food)(Required)

Daily medications, vitamins, or treats(Required)

Hidden

Section Break

Do you grant permission for our staff to take photographs of your pet for social media/website?(Required)

Yes

Reason for visit?(Required)

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Ready to Visit?

We look forward to seeing you and your pet! Easily request an appointment for your pet using our online system on PetDesk and keep up with your pet’s health by downloading our app!

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