New Client RegistrationNew Client RegistrationNew Client Registration FormClient InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone(Required)Email(Required) Patient InformationPet Name(Required)Age/Date of Birth(Required)Type of pet(Required) Dog Cat OtherOther(Required)Breed(Required)Gender(Required) Female Male Spayed/NeuteredColor(Required)Previous/Regular Veterinarian:Reason for today’s visit:(Required)Do you have another pet? Yes NoPet #2 NameAge/Date of BirthType of pet Dog Cat OtherOtherBreedColorGender Female Male Spayed/NeuteredPrevious/Regular Veterinarian:Reason for today’s visit:Fees(Required) I understand that all professional fees are due at the time services are rendered.Cancellation(Required) I understand that a missed appointment or late cancellation (under 24hr notice will result in a $42 charge)Photos(Required) I grant Touhy Animal Hospital to use my pet's image (photo or video) in Social Media publicationSignature(Required)(type full name)Please allow 24 hours for prescription refills Please note our cancellation policy: A cancellation made with less than a 24 hour notice significantly limits our ability to make the appointment available for another patient in need. Appointment cancellations with less than 24 hours notice will incur a $42.00 charge. Grooming appointments with less than 48 hours notice will incur a $42.00 charge. Surgery/Specialist appointments with less than 48 hours notice will forfeit their deposit.Δ Download & Print Form
