If you are a current client of ours, use this form to register a new pet with us. If you are a new client, please fill out this form: New Client Registration. New Pet - Current Client About YouYour Name* First Last Co-Owner's Name First Last Email* Phone*About Your PetPet's Name SpeciesChoose…DogCatRabbitFerretGuinea PigHamsterMinkChinchillaBirdOtherOr if other species Breed, if known Color Date of Birth, or Age, if known Special Identification (tattoo, microchip, etc.)Sex Neutered Male Spayed Female Male Female Unknown Previous Veterinary Practice (if any) Previous Veterinarian (if any) Date of last vaccines (if known) 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 supplementWhat food does your pet eat?Does your pet have allergies or drug reactions? Yes No Do Not Know If Yes, please list the allergies and reactionsAre 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 conditionsPhoto of Your PetFeel free to upload a clear photo of your pet.Max. file size: 256 MB.Please use the following box to give us any other relevant information about your petMiscellaneousPermission To Use Pet Pictures*I hereby give Susquehanna Trail Animal Hospital the absolute and irrevocable rights to use my pets name and pictures on the web site and/or social media sites (Facebook, Instagram, etc.) for display, public relations, and marketing. I hereby acknowledge receipt of adequate consideration and waive the right to charge for use of the pictures or to inspect or approve the images prior to any form of usage. I understand that the images may be modified to be used as design elements. Yes No
