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New Client Registration Form
Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.
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.
Owner's Name
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County
*
Day-Time Phone
*
Evening Phone
Mobile Phone
*
Email
*
Enter Email
Confirm Email
Preferred Method of Communication:
*
Text Message
Phone
Email
No Preference
Co-owner's Name & Contact #
Name
First
Last
Phone
How did you find out about our practice?
*
Personal Referral
Internet Search / Website
Social Media
Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Are you ready to schedule an appointment?
*
Yes
No
If you answered "Yes" to the previous question, please fill out the following form: https://happierathomevet.com/request-an-appointment/
Please use this area to give us any other relevant information about yourself or your family
I understand payment is due in full at the time services are rendered. Any delay in payment will incur a daily fee for each subsequent day that payment is late.
*
Yes, I understand
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Rabbit/Guinea Pig
Ferret
Reptile
Other
If "Other" species, please specify.
Breed
*
Color
Date of Birth or Age
*
Special Identification (tattoo, microchip, etc.)
Sex
*
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice
*
May we contact them for previous history?
*
Yes
No
Is your pet on any medication or supplement?
Yes
No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
Yes
No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Fear Free Questions
We want to make your pet’s veterinary experience as enjoyable and as stress-free as possible.
Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.
Select All
Getting in their carrier or the car
Entering the veterinary hospital
Being approached by veterinary staff
Getting on the scale for a weight
Being put up on the table for examination
Loud voices during examination
Having a rectal temperature taken
Having direct eye contact with the technician and/or veterinarian
The use of instruments such as the stethoscope or otoscope (to look in the ears)
How would you describe your pet around other animals and people?
Does your pet have any sensitive areas that s/he does not like to have touched by you or others?
Are there any procedures your pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) if so, how did your pet react?
What are your pet’s favorite treats? (Please bring some to your next visit with us):
Does your pet like to play with toys? If so, what kinds?
Has your pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did your experience?
Anything else you would like us to know?
Would you like to add an additional pet?
Yes
No
Second Pet's Name
*
Second Pet's Species
*
Dog
Cat
Rabbit/Guinea Pig
Ferret
Reptile
Other
If "Other" species, please specify.
*
Second Pet's Breed
*
Second Pet's Color
Second Pet's Date of Birth or Age
*
Second Pet's Special Identification (tattoo, microchip, etc.)
Second Pet's Sex
*
Neutered Male
Spayed Female
Male
Female
Unknown
Second Pet's Previous Veterinary Practice
*
May we contact them for previous history?
*
Yes
No
Is your second pet on any medication or supplement?
Yes
No
If Yes, please list second pet's medication or supplement
What food does your second pet eat?
Does your second pet have allergies or drug reactions?
Yes
No
If Yes, please list second pet's allergies and reactions
Are there any current or past medical conditions of which we should be aware?
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Fear Free Questions
We want to make your pet’s veterinary experience as enjoyable and as stress-free as possible.
Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.
Select All
Getting in their carrier or the car
Entering the veterinary hospital
Being approached by veterinary staff
Getting on the scale for a weight
Being put up on the table for examination
Loud voices during examination
Having a rectal temperature taken
Having direct eye contact with the technician and/or veterinarian
The use of instruments such as the stethoscope or otoscope (to look in the ears)
How would you describe your second pet around other animals and people?
Does your second pet have any sensitive areas that s/he does not like to have touched by you or others?
Are there any procedures your second pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) if so, how did your pet react?
What are your second pet’s favorite treats? (Please bring some to your next visit to our hospital):
Does your second pet like to play with toys? If so, what kinds?
Has your second pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did your experience?
Anything else you would like us to know about your second pet?
Would you like to add an additional pet?
Yes
No
Third Pet's Name
*
Third Pet's Species
*
Dog
Cat
Rabbit
Ferret
Reptile
Other
If "Other" species, please specify.
*
Third Pet's Breed
*
Third Pet's Color
Third Pet's Date of Birth or Age
*
Third Pet's Special Identification (tattoo, microchip, etc.)
Third Pet's Sex
*
Neutered Male
Spayed Female
Male
Female
Unknown
Third Pet's Previous Veterinary Practice
*
May we contact them for previous history?
*
(Please enter "Yes" or "No")
If Yes, please list the third pet's medication or supplement
What food does your third pet eat?
Does your third pet have allergies or drug reactions?
Yes
No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Fear Free Questions
We want to make your pet’s veterinary experience as enjoyable and as stress-free as possible.
Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end.
Select All
Getting in their carrier or the car
Entering the veterinary hospital
Being approached by veterinary staff
Getting on the scale for a weight
Being put up on the table for examination
Loud voices during examination
Having a rectal temperature taken
Having direct eye contact with the technician and/or veterinarian
The use of instruments such as the stethoscope or otoscope (to look in the ears)
How would you describe your third pet around other animals and people?
Does your third pet have any sensitive areas that s/he does not like to have touched by you or others?
Are there any procedures your third pet has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw) if so, how did your pet react?
What are your third pet’s favorite treats? (Please bring some to your next visit to our hospital):
Does your third pet like to play with toys? If so, what kinds?
Has your third pet ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did your experience?
Anything else you would like us to know about your third pet?
Home
About Us
Our Team
Services
Wellness and Vaccinations
Preventive Services
Medical Services
Surgical Services
Anesthesia and Patient Monitoring
Exotic Pet Medicine and Surgery
In-home Euthanasia
Pet Health
How-To Videos
Pet Food Recalls
Product Recalls
Contact Us
New Client Form
Online Pharmacy