New Client/Patient Registration Form
Thank you for choosing 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).
Are you an existing Client? * Yes No Owner's Name Name *
First Last Address * Email * Co-Owner's Name & Contact # Name
First Last General Information Reason for this appointment * New Pet Owner New to the area Second opinion Not able to see my own vet Other If you are coming because you are not able to see your own vet, please clarify if this is a new condition that is an emergency, or an ongoing condition. If you can not see your own vet, please tell us why are you coming to us and how urgent this is. Is your pet a dog, 1-8 years old, docile temperament, 55+ pounds and would you like to have them join or know more about our blood donor program? Yes No
Check out more info on our website, or reach out to us for further information. https://roncesvallesanimalhospital.com/blood-donor-information/
Pet Information Gender * Neutered Male Spayed Female Male Female Unknown Are there any current or past medical conditions of which we should be aware? * Yes No Is your pet on any medication or supplement? * Yes No Does your pet have allergies or drug reactions? * Yes No Does your pet show any signs of fear, stress, anxiety or aggression during veterinary visits? * Yes No
If yes, please contact us prior to your appointment date to receive a calming package. This will ensure we can complete a thorough physical exam and avoid having to reschedule your appointment if we are unable to.
We are practicing as a fear free clinic and would like our patients to be as comfortable as possible while in our care.
Do you have pet insurance? * Yes No Payment and Cancellation Policy *
For payments we are accepting all major credit cards, Debit, e-transfers or cash.
1. Cancellation within 24 hours of APPOINTMENT time - $37.50 2. Missed APPOINTMENT or more than 10 minutes late for scheduled appointment time - $52.50 3. Missed drop off or cancellation within 72 hours of SURGERY time - $250 We appreciate your consideration and understanding of this policy. Social Media At times during your pet’s visit, we may take pictures. Your consent here will act as authorization to use these pictures on Roncesvalles Animal Hospital Facebook, Instagram and social media pages. * Yes No How did you hear about us? * Friends & Family Dog park Social Media (Facebook, IG, etc) Web search (Google) Magazine or Newspaper Other