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New Patient Registration Form

Redding Veterinary Hospital, LLC — 235 Ethan Allen Highway, Ridgefield, CT 06877

Help us give your pet the best care by filling out this form. Please provide your pet's current medical records to us.

Why did you bring your pet in today?

Pet Information

Pet's Name *

Species *

Breed

Age

Sex

Male

Female

Spayed/Neutered?

Yes

Contact Information

Your Name *

Email (we do not share email) *

Address

City / State / Zip Code

Home #

Cell #

Work #

Preferred Contact Method

Pet Details

Pet Insurance?

Yes

Name of Insurance

Indoor / Outdoor?

Indoor

Outdoor

Both

Microchipped?

Yes

Heartworm Preventative?

Yes

Heartworm Product Used

Flea & Tick Preventative?

Yes

Flea & Tick Product Used

In the last 6 months, my pet has had changes in:

EatingDrinkingUrinationDefecationVomitingCoughingSneezingDiarrheaSkinAttitude/EnergyLamenessEyesEarsTeeth

Other

I am interested in information on:

Behavior/TrainingPet InsuranceWellness CareVaccinesBreedingSpay/NeuterDental CleaningDiet & NutritionFleas & TicksHeartwormWeight LossMicrochippingGroomingBoarding

Other

Current Medications or Supplements

Please list ALL meds & supplements with dosage.

Medication 1

How Much

How Often

Medication 2

How Much

How Often

Medication 3

How Much

How Often

Diet

Please include brand & type of food, including any treats, table scraps, etc.

Food 1

How Much

How Often

Food 2

How Much

How Often

I understand that I am responsible for payment at the time of service, unless prior arrangements have been made, regardless of pet insurance coverage.

We care about our clients and their pets. Thank you for your business!