New Client Form

Thank you for considering 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).

NEW CLIENT REGISTRATION FORM

Sections marked with a red asterisk are required. If a question does not apply to your pet, or if you do not know the answer, please put "N/A" or "Unknown."

Owner's Contact Information

* Indicates required field

Client Name *

First

Last

Client Birthday *

Email *

Primary Phone Number *

Phone Type: *

Mobile Home Work

Address *

Line 1

Line 2

City

State

Zip Code

Country

Co-owner Name *

First

Last

Co-owner Phone *

If other, please let us know how you found us! *

If someone referred you, who may we thank? *

Pet Information

Pet's Name *

Date of Birth or Approximate Age (if known) *

Species *

Dog Cat Other

Breed (if known) *

Color(s) *

Is your pet microchipped? *

Yes No I don't know

If so, please provide microchip number (if known): *

Pet Medical History

We require that any existing records and medical history is received prior to scheduling an appointment for your pet. This helps ensure that our doctors are able to review patient history prior to your appointment date. Please note that we will contact previous veterinary clinics listed below to obtain medical records.

Please list name, phone number, and location of all previous veterinary hospital(s). If your pet has never been seen by veterinarian, please provide information from the breeder or rescue organization as we will need to obtain all medical history that is available. *

Any other names (owner name or pet name) that your pet may be listed under at previous veterinary hospital? *

Is your pet currently or recently shown any symptoms of illness, such as an infection, coughing, sneezing, discharge, etc.? *

Is your pet up to date on vaccines? If no, please list vaccines needed. *

Does your pet have a chronic/acute condition? If so, please describe. *

Is your pet currently taking any medications/supplements or on a prescription diet? If so, please list. *

Does your pet suffer from any known allergies or drug reactions? If so, please list. *

Do you have any specific needs, concerns, questions, comments? If so, please note below: *

Submit Form

OFFICE HOURS

Monday 7:30 am - 6:00 pm
Tuesday 7:30 am - 6:00 pm
Wednesday 7:30 am - 6:00 pm
Thursday 7:30 am - 6:00 pm
Friday 7:30 am - 6:00 pm
Saturday 8:00 am - 12:00 pm
Sunday 5:00 pm - 6:00 pm*
*Sundays~ boarding services only

CONTACT INFORMATION

Adams Farm Animal Hospital, P.A.
5502 Adams Farm Lane
Greensboro, NC 27407

Phone: 336-854-5980
Text: 336-383-1487
Fax: 336-852-4861
Email: [email protected]

Carolina Veterinary Specialist and Emergency Hospital
501 Nicholas Road
Greensboro, NC 27409
Phone: 336-632-0605

Happy Tails Veterinary Emergency Clinic
4525 Lawndale Dr.
Greensboro, NC 27455
Phone: 336-288-2688

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Welcome to the family!

NEW CLIENT REGISTRATION FORM

Owner's Contact Information

Pet Information