Tar River Veterinary Hospital

101 E. Green St.
Franklinton, NC 27525

(919)494-5500

tarrivervet.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice? (required)
Yes
No


Name of Former Veterinary Practice (if not applicable please type "N/A") (required)

Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Tar River Veterinary Hospital and that charges are due and payable at the time of service. I also understand that I am responsible for the transfer of medical records from my previous veterinary practice. Tar River Veterinary Hospital is not responsible for acquisition of a client's medical records. If prior medical records are not available or given, I understand that Tar River Veterinary Hospital has the right to deny service.
I have read this statement and -
I Agree
I Disagree



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