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New Client Registration Form

As a new client, if you have not already done so, please call into the office to set up an appointment after filling out the form. Thank you.
Owner's Name
Name*



First



Last


Address*



Street Address


Address Line 2


City


State / Province / Region


ZIP / Postal Code

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Country


Day-Time Phone*
Evening Phone
Mobile Phone
Email*



Enter Email



Confirm Email


What is your preferred form of communication?
This allows the doctors to know which communication you prefer when relaying lab results. 
Phone
E-mail
Co-owner's Name & Contact #
Name



First



Last


Phone
How did you find out about our practice?
Clinic Location
Personal Referral
Internet Search / Website
Yellow Pages
Clinic Sign
Newspaper / Print Media
Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
DogCatRabbitFerretBirdReptile
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Neutered MaleSpayed FemaleMaleFemaleUnknown
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)


Date Format: MM slash DD slash YYYY

What vaccines were given at this time
Is your pet on any medication or supplement?
Yes
No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
Yes
No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet


 












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Where to Find Us

1 Gibralter Way

Greensburg, PA, 15601
 
Call: (724) 216-5174

Email: info@kvetac.com
Mon-Thurs: 8:00 am-6:00 pm

Friday: 8:00 am-6:00 pm

Saturday*: 9:00 am-12:00 pm

Sunday: Closed
 
*Medication pick-ups and specimen drop-offs only. No vet available on Saturday.

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