New Client Registration Form

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). The required sections have a red * asterisk.

Are you a current client?

Yes No

Primary Contact Name

Alternate Contact Name (if applicable)

Mailing Address

City

State / Province / Region

ZIP / Postal Code

Main Phone Number

Main Phone Type

Name Associated with Main Phone

Alternate Phone

Alt Phone Type

Name Associated with Alt Phone

Pet's Name

Gender

Spayed/Neutered?

Birthdate (MM/DD/YY)

Weight (if known)

Species

Breed

Color/Markings

Microchip ID# (if known)

What is the reason you're submitting records? (New Client and/or Pet for Wait List, Wellness and Vaccines, Illness, 2nd Opinion, Surgery, etc)

Please include any specific info you have about your pet (previous vet visits, vaccines, health concerns, etc). You may also attach records using the Upload Link Below.

How did you hear about us? (select one)

Please submit all your information using the button below. We will get back to you regarding your records submission as soon as possible. If you have other records you could not fill or attach to this form, you can email them directly to info@manchestervets.com. Thank you!

I assume responsibility for all charges incurred in the care of this animal. I also understand these charges will be paid at the time of service or release and that deposit may be required for surgical treatment.

I agree to the Terms & Conditions

New Client Registration Form

Save $50 on Your Pet’s Next Visit