GVH New Client Registration

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. 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.

Owner Information

Primary Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

This will be the main phone number used to contact you. If this is a cell phone number, you will receive text reminders for appointments. You can opt out if you wish not to receive them.

{ binding firstError.message }

All email communications will be sent here, such as receipts, health service reminders and appointment reminders.

{ binding firstError.message }

This will ONLY be needed if you intend to pay with a check. 

{ binding firstError.message }

Please indicate which of the following apply to you so that we can expedite your submission.

{ binding firstError.message }
Co-owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Do you have a prefered doctor? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Authorization and Releases

I hereby authorize the veterinarian to examine, prescribe for, or treat my pet(s). I understand that these charges must be paid in full at the time of release and a deposit may be required for hospitalization and surgical treatment. An estimate will be provided, upon request, prior to treatment, for approval. 

{ binding firstError.message }
{ binding firstError.message }
Release of Medical Information {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Do you authorize the release of vaccine and medical information to groomers and boarding facilities of your choice?

Photo Release {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Do you authorize the staff of this hospital to photograph your pet in pleasant scenarios and use the photos on the hospital's social media outlets, including Facebook, Instagram and Twitter? (Special permission would be obtained for photos of your pet during surgery, dental procedures, wearing a muzzle or any other kind of photo where your pet wasn't apparently happy.)

{ binding firstError.message }
{ binding firstError.message }

Pet Information

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

If exact date is unknown, give an approximate date.

{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Information

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

If exact date is unknown, give an approximate date.

{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Information

{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

If exact date is unknown, give an approximate date.

{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Insurance

{ binding firstError.message }
{ binding firstError.message }

If you do not yet have pet insurance but would like more information, please go to our website! https://gtvet.com/pet-health-insurance/ We give you the names of a few companies some of the staff and our clients use. You'll also find links with coverage questions and a comparison chart to help you make the best decision for your family. Please let us know if you have any questions!

{ binding firstError.message }

Previous Vaccine and Medical Records

 PLEASE READ CAREFULLY:

If your pet's previous vaccine or medical records are at one of these 3 places, we will need your help obtaining the information. 

  • Banfield Pet Hospital - they will not release records to us unless you call and give your permission. The fastest way to get us your pet's records is for you to call and ask them to email the records to us at recep@gtvet.com.
  • Emancipet - you will need to sign a release form on their website before we can obtain records.
  • Dr. Tarleton at Austin Ave. Animal Hospital - Dr. Tarelton keeps paper records and does not have access to email or a fax machine. You will need to bring your records in for us to copy.
{ binding firstError.message }

GVH New Client Registration

GVH New Client Registration

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. 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.

Owner Information

Primary Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Primary Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Driver's Licence Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Reason for completing the New Client Registration: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of scheduled upcoming appointment, if any. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Co-owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Co-owner's Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Do you have a prefered doctor? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is there anyone we can thank that referred you to us? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Authorization and Releases

I hereby authorize the veterinarian to examine, prescribe for, or treat my pet(s). I understand that these charges must be paid in full at the time of release and a deposit may be required for hospitalization and surgical treatment. An estimate will be provided, upon request, prior to treatment, for approval. 

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Release of Medical Information {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Photo Release {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Please use this area to give us any other relevant information about yourself or your family {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Pet Information

1st Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Species {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Color {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth/Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Microchip Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of last vaccines {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Previous Veterinary Practice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please list any medications or supplements your pet takes. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
List any allergies or reactions your pet has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Describe any past or current medical conditions your pet has had or has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please tell us anything else you'd like us to know about your pet. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Information

2nd Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Species {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Color {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth/Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Microchip Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of last vaccines {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Previous Veterinary Practice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please list any medications or supplements your pet takes. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
List any allergies or reactions your pet has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Describe any past or current medical conditions your pet has had or has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please tell us anything else you'd like us to know about your pet. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Information

3rd Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Species {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Color {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth/Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Microchip Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of last vaccines {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Previous Veterinary Practice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Can we contact them on your behalf to request vaccines and medical history? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please list any medications or supplements your pet takes. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
List any allergies or reactions your pet has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Describe any past or current medical conditions your pet has had or has. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Please tell us anything else you'd like us to know about your pet. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Pet Insurance

With which company is your pet or pets insured? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What is the policy number? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

If you do not yet have pet insurance but would like more information, please go to our website! https://gtvet.com/pet-health-insurance/ We give you the names of a few companies some of the staff and our clients use. You'll also find links with coverage questions and a comparison chart to help you make the best decision for your family. Please let us know if you have any questions!

{ binding firstError.message }

Previous Vaccine and Medical Records

 PLEASE READ CAREFULLY:

If your pet's previous vaccine or medical records are at one of these 3 places, we will need your help obtaining the information. 

  • Banfield Pet Hospital - they will not release records to us unless you call and give your permission. The fastest way to get us your pet's records is for you to call and ask them to email the records to us at recep@gtvet.com.
  • Emancipet - you will need to sign a release form on their website before we can obtain records.
  • Dr. Tarleton at Austin Ave. Animal Hospital - Dr. Tarelton keeps paper records and does not have access to email or a fax machine. You will need to bring your records in for us to copy.
{ binding firstError.message }