New Client Form


Welcome, New Clients!

We know your pet’s health is important and we thank you for trusting us to care for them. To help us provide the best care possible, please take a few moments to fill out this form completely.

Thank you for your cooperation in letting us assist you.


"*" indicates required fields

Please select the location you will be visiting*

Client Information

Getting in touch with you is important and we need to keep your contact information current. We may ask you to fill out this form again from time to time. Thanks for your cooperation!
Owner Name**

Owner Telephone and Email

Co-Owner Details

Wish to designate someone as a co-owner of your pet? This person can make decisions on your behalf in the event that you are not available.

if you wish to designate a co-owner, please fill out the following fields.
Co-Owner Name

How did you hear about us?

We like to share photos and stories about our patients with members of the online community. Can images of your pet(s) be used on Facebook, Instagram, or our website?*


I authorize the veterinarians and staff of Companion Pet Hospital to administer treatment and/or perform diagnostic procedures as agreed upon and deemed necessary.

I assume full responsibility for all charges incurred in the care of my pet and understand that payment is due at the time of service.
Please Type in Your Full Name as Acknowledgement of the Above:*
This field is for validation purposes and should be left unchanged.