New Client Registration

Indian Walk Veterinary Center 662 Durham Road Newtown, PA 18940		Phone: 215-598-9000 Fax: 215-598-9877
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Please fill out the registration form completely before submitting. Fields marked with an * are required. If you prefer, you may download our Client Registration Form as a PDF, fill it out at home and bring it to your first appointment.
If your pet is "exotic" (i.e. not a cat or dog), please print the Exotic Pet Registration Form, fill out completely, and bring it to your first appointment. This will help us to get to the purpose of your visit more efficiently.
You should receive a confirmation phone call within 48 hours.
If you need an emergency appointment, do not register on-line. Call our office at 215-598-9000 for immediate help.

*Your Name:

Spouse or Other
Responsible Party:

*Street Address:

*City:

*State:
*Zip Code:

*Home Phone:

Cellular Phone:

Work Phone: Extension:

*E-mail:

Where/when do you
prefer to be contacted? Home
Work
Cell

How did you first
hear about us?

Yellow Pages Ad
Passing By
Our Web Site
Other Internet Site
Other Source

Person we may thank for referring you:
Clients receive a $15 credit for referring others.

Please provide information about your previous veterinary care so we can have your pet's records transferred.

*Veterinarian:

Hospital:

*Location:

*Phone:

FAX:

*Pet's Name:

*Type of Animal:

*Date of Birth:

*Breed:

Color:
(You may choose
more than one)                     *Sex: select 1
                 Male    FemaleNeuterSpay

(Cats only)
Declawed? Yes No

*Percentage of time your pet is outdoors

Your pet's normal diet (as specific as possible):

Canned:

Dry:

Treats:

"People Food":

*Has your pet had any serious health problems or surgeries in the past?

*Does your pet have any current or chronic health problems?

*Current medications or supplements you are giving your pet:

If you have more than one pet, follow the link on the next page after you click the "Submit" button.

Home • New Client Registration • Visit Our Library • Interests • Meet Our Staff • See Our Services • Take a Tour • The PAWs Fund

*Your Name:
Spouse or Other Responsible Party:
*Street Address:
*City:
*State:		*Zip Code:
*Home Phone:
Cellular Phone:
Work Phone:			Extension:
*E-mail:
Where/when do you prefer to be contacted?	Home Work Cell
How did you first hear about us?	Yellow Pages Ad Passing By Our Web Site Other Internet Site Other Source

Please provide information about your previous veterinary care so we can have your pet's records transferred.
*Veterinarian:
Hospital:
*Location:
*Phone:
FAX:

*Pet's Name:
*Type of Animal:
*Date of Birth:
*Breed:
Color: (You may choose more than one)		*Sex: select 1 Male FemaleNeuterSpay
(Cats only) Declawed?	Yes No
*Percentage of time your pet is outdoors

Your pet's normal diet (as specific as possible):
Canned:
Dry:
Treats:
"People Food":

*Has your pet had any serious health problems or surgeries in the past?
*Does your pet have any current or chronic health problems?
*Current medications or supplements you are giving your pet: