Patient Forms Get a Jumpstart! Please complete the new client registration form at least 24 hours prior to your first appointment. New Patient Registration Form "*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.Owner Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone*By providing your phone number, you are agreeing to receive calls and text messages regarding your pet's health and medical reminders from Bon Air Pet Hospital. You can opt out at any time.Secondary PhoneOwner Email* By providing your email address, you are agreeing to receive emails regarding your pet's health, medical reminders and news about Bon Air Pet Hospital.Owner Date of Birth* Month Day Year How did you find us?--- Please select ---Internet SearchSocial MediaYelpReferralOtherIs there a secondary owner or spouse we should add for this pet(s)?* Yes No Spouse / Secondary OwnerSpouse / Secondary Owner Name* First Last Spouse / Secondary Owner Phone*Spouse / Secondary Owner Email* Pet Information Please complete all information below.Pet Name*Species* Dog Cat Other Breed*Date of Birth (or approximate)* Month Day Year Color*Sex* Male Female Is your pet spayed or neutered?* Yes No Microchip Number (if known)Has this pet been a patient of another veterinary clinic(s)?* Yes No Please upload previous veterinary records Drop files here or Select files Max. file size: 98 MB, Max. files: 5. If you do not have previous records to upload, please tell us who to contact to retrieve these records:Do you have a second pet to add?* Yes No Second Pet Information Please complete all information below.Pet Name*Species* Dog Cat Other Breed*Date of Birth (or approximate)* Month Day Year Color*Sex* Male Female Is your pet spayed or neutered?* Yes No Microchip Number (if known)Has this second pet been a patient of another veterinary clinic(s)?* Yes No Please upload previous veterinary records Drop files here or Select files Max. file size: 98 MB, Max. files: 5. If you do not have previous records to upload, please tell us who to contact to retrieve these records:Do you have a third pet to add?* Yes No Third Pet Information Please complete all information below.Pet Name*Species* Dog Cat Other Breed*Date of Birth (or approximate)* Month Day Year Color*Sex* Male Female Is your pet spayed or neutered?* Yes No Microchip Number (if known)Has this third pet been a patient of another veterinary clinic(s)?* Yes No Please upload previous veterinary records Drop files here or Select files Max. file size: 98 MB, Max. files: 5. If you do not have previous records to upload, please tell us who to contact to retrieve these records:Social Media Release Bon Air Pet Hospital occasionally features client pets on our social media accounts. By opting in, you give your consent for your pet(s) to be featured. We will never post medical or case photos or information without additional consent from you.Social Media Consent* Yes, I consent. No, I do not want my pet(s) featured on social media or other digital or print media. Policy ConfirmationConsent to Treat* As the owner of this pet(s), I hereby authorize Bon Air Pet Hospital to render medical care for my pet(s) as deemed necessary by a veterinarian. I understand no guarantee can be given to the outcome of medical treatments and/or surgeries and take it as my responsibility to comprehend any risks involved. I authorize Bon Air Pet Hospital to render care and provide the supplies and medications necessary, knowing that in some cases certain drugs may be used off-label. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of the patient from Bon Air Pet Hospital.
