New Client Registration

Welcome to our practice! We look forward to serving you and your pets. Save time checking in by filling out the following form for your first visit!

Pet Owner
Name *
Name
Please let us know who referred you so that we may thank them with a gift
Home Address *
Home Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Work Phone
Work Phone
Co-Owner (if applicable)
Cell Phone
Cell Phone
Work Phone
Work Phone
Emergency Contact
Someone we may call if we cannot contact the owner in the event of an emergency
Phone
Phone
Pet's Information
Name
Date of Birth
Date of Birth
Name
Date of Birth
Date of Birth
Name
Date of Birth
Date of Birth
Payment Policy
River Road Animal Hospital accepts American Express, Discover, Master Card, Visa, Care Credit and Cash. Full payment is expected at the time of service. 50% Deposit is required for all hospitalization and surgery. Service charges will be applied for collections and balances not paid in full.