New Client Form | Arlington Pet Hospital

Welcome, New Clients!

We are so excited to see you. Please fill out your new client form ahead of your appointment by downloading the PDF using the button below, or enter your information directly and it will be sent to our team. We look forward to seeing you soon.

DOWNLOAD PDF

"*" indicates required fields

Pet Owner Information

Name*

First* Last*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street* City* State* Zip Code*

Spouse Name

First Last

Spouse Phone Number

Driver's License or Social Security Number*

One or the other

Pet Information

Pet's Name*

Age or Date of Birth*

Species*

Dog

Cat

Breed*

Color*

Gender*

Reason for Today's Visit

General Wellness Exam

Illness

Surgery/Consult

Grooming

Current Medications

Scribe Note Consent

Arlington Pet Hospital may utilize a scribe service to record your pet’s appointments for improved clinical documentation. By visiting Arlington Pet Hosptial, please understand your vet appointments may be recorded to enhance the accuracy and efficiency of your pet’s medical records.

Disclaimer:

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet I assume responsibility for all charges incurred in the care of this animal. I understand that these charges must be paid at the time of release and a deposit may be required for surgical treatment.

Signature*

First* Last*

Date*

CAPTCHA

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