New Client Form for Yorkville Animal Hospital

Cheerful interracial couple in sweaters playing with chihuahua dog on bed at home

We’re glad you found us! Before your first visit, please complete the new client form below so we can get to know you, your pet, and the important details that help your appointment run smoothly.

This form gives our team a head start on your pet’s medical history, lifestyle, current needs, and any concerns you’d like to discuss. Once it’s submitted, we’ll have the basics ready so we can focus on your pet, not paperwork.

New Client Registration

Owner Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Country

Partner/Co-Owner's Information

Partner/Co-Owner's Name
Partner/Co-Owner's Name
First Name
Last Name
Address (if different from above)
Address (if different from above)
City
State/Province
Zip/Postal
Country

Pet Information

Species
Is your pet microchipped?
Do you have pet health insurance?
Is your pet on any medication or supplement?
Does your pet have allergies or drug reactions?
Are there any current or past medical conditions of which we should be aware?