New Patient Form

Primary Owner

First Name*

Last Name*

Phone Number*

Co-Owner

First Name*

Last Name*

Phone Number*

Address

Street Address*

Street Address Line 2*

City*

State*

Zip*

Email*

Pet Information

Pet's Name*

Date of Birth*

Pet Breed*

Pet Color*

Pet Species*

Pet Gender*

Pet Origin*

If Other, please list here

Pet History

Current Medications (including over the counter)*

Previous Surgeries/Medical Procedures*

Previous Vet Hospital Name

Previous Vet Hospital Number

Please upload any of your pet's previous vaccination information or medical records here and they will be sent directly to the hospital with this completed form.

How Did You Hear About Us*

Ocassionally we use photos of clients' pets on our Facebook and Instagram without using last names. Do we have your permission to use your pet's photo on our social media sites?*

Appointment Cancellation/No-Show Policy- When you schedule an appointment with SHV, we set aside enough time to provide you with the highest quality care. Should you need to cancel or rescheduled an appointment please contact our office as soon as possible, and no later than 24 hours prior to your scheduled appointment. This gives us time to schedule other patients who may be waiting for an appointment. Effective 3/7/2022 any established patient who fails to show or cancel/reschedule an appointment and has not contacted our office with at least 24 hours’ notice will be considered a No Show and charged a $50.00 fee. Please initial below you have been advised of this policy.

I accept

I certify that I am the owner of the above pet and that all information is accurate. I am responsible for payment to Shore Haven Veterinary Hospital for all treatment given to my pet. We accept cash, American Express, MasterCard, Visa, and Discover. For your convenience, we have partnered with Care Credit and Scratchpay for all billing services. Please note: payment is required at the time of services rendered. Please sign below to accept these terms.

I accept

We're Excited to Meet You!

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