New Patient Form

We appreciate you entrusting River Road Animal Hospital with your pet’s care. To help us better understand your pet’s needs, kindly complete the required New Patient Form below.

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New Patient Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before you arrive.

New Patient Form

Name *

First

Last

Spouse

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Primary Phone *

Secondary Phone

Communication preference (check all that apply):

Email
Text
Phone

How would you like to receive your pet’s reminders?

By Mail
By Email

May we use your pet’s photo on our social media?

Whom may we thank for referring you?

Pet Information

Pet's Name *

Age or Date of Birth *

Breed *

Colour *

Species *

Sex *

Male
Female
Neutered Male
Spayed Female

Pet’s Medical History / Illness

List any medications:

Is your pet current on vaccinations? *

Previous Weight: *

Add another pet? *

Payment Information

ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. DEPOSITS ARE REQUIRED FOR ALL HOSPITALISED PATIENTS. I will be paying by:

Cash
Cheque
Credit Card (Visa, Mastercard, Discovery or American Express)

Please note: Our cheque clearing service requires us to view and record identification before accepting cheque payments. A $25.00 fee will apply to returned cheques. If a cheque is returned, all future services must be paid for by cash or credit card.

Do you have pet insurance? If yes, please list which company.

Signature *

Clear Signature

Date *

New Patient Form

New Patient Form

New Patient Form

Schedule Your Pet’s Visit Today

Location

Contact Information

Hours

Have a Question?