Your Name: We need your full name to create a client account in our system.

Email Address: Your email address will be used for communication, including appointment reminders and updates about your pet's health.

Phone Number: Having your phone number allows us to contact you quickly if needed, such as for urgent updates about your pet.

Address: Your address is important for maintaining accurate records and ensuring we can reach you if necessary.

Pet's Name: We'll need the name of the pet you're registering as a new client.

Pet Type: Indicating whether your pet is a dog or cat, helps us prepare for their specific needs.

Pet's Age: Knowing your pet's age assists our veterinarians in providing appropriate care and treatment.

Pet's Gender: Understanding your pet's gender is important for certain medical considerations.

Pet's Breed: The breed of your pet can provide helpful information about potential health concerns or predispositions.

By submitting the new client registration form, you are agreeing to the following terms and conditions:

Accuracy of Information: All information provided on the form must be true and accurate.

Financial Responsibility: You will be responsible for the cost of any veterinary services provided to your pet.

Updated Information: You agree to notify the clinic of any changes in your contact information or your pet's health.

Please review these terms carefully before submitting the form. If you have any questions or concerns, feel free to contact our office.

Thank you for choosing VetiVa. We look forward to providing exceptional care for your pet!

To ensure we provide the best possible care for your pet, please provide the following information about their medical history:

Previous Veterinary Clinics: List any veterinary clinics your pet has visited in the past, including the clinic name and the approximate dates of care.

Vaccination History: Provide details on the vaccinations your pet has received, including the type of vaccine, the date it was administered, and the next scheduled booster.

Spay/Neuter Status: Indicate whether your pet has been spayed or neutered, and if so, please provide the approximate date of the procedure.

Past or Current Medical Conditions: List any ongoing or previous medical conditions, injuries, or illnesses your pet has experienced, along with the approximate dates and any treatments provided.

Current Medications: Provide the name, dosage, and frequency of any medications your pet is currently taking, including prescription drugs, over-the-counter supplements, or flea/tick preventatives.

Allergies or Sensitivities: Note any known allergies or sensitivities your pet has, such as to certain foods, medications, or environmental factors.

Behavioral Concerns: Mention any behavioral issues your pet may have, such as aggression, anxiety, or phobias, that our veterinary staff should be aware of.

Secondary Emergency Contact: Provide the name and contact information of an emergency contact who can make decisions about your pet's care if you are unavailable.

Please ensure the information you provide is as accurate and detailed as possible. This will help our veterinary team deliver the best possible care for your pet. If you have any questions or need assistance completing this section, please don't hesitate to ask our staff.

For referral cases, we will request the client's medical records from the previous clinic.

For other consultation cases, if the client has records from other clinics, the clients are welcome to provide those records for reference.

We will directly send the complete medical record to the requesting clinic.

Clients can request and receive copies of history, laboratory reports and imaging studies (e.g. X-rays, Ultrasounds) from us.