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New Client Form
Thank you for choosing Kings Highway Animal Clinic! Please fill out the information below to complete your account setup and so that we may learn a little more about your pet!

If you have multiple new patients, please complete this form with the first pet, then fill out a New Patient Form for each additional pet.

If you have any questions, please do not hesitate to contact us!

First Name *
Your answer
Last Name *
Your answer
Spouse/Co-Owner
If you would like to add a spouse or co-owner to the account, please provide their full name below. Please note that only persons listed on the account will be able to make medical and financial decisions regarding the pets on the account. Please select their relationship to you in the next section.
Your answer
Co-Owner Relationship
Address (Street, City, State, Zip) *
Your answer
County *
Cell Phone *
Your answer
Home/Alternate Phone *
Required
Spouse/Co-Owner Phone Number
Your answer
Email Address *
Providing your email address allows us to send appointment and vaccination reminders for your pets. You may always opt out of emails you do not wish to receive.
Your answer
Emergency Contact *
In the event we are unable to reach you, please provide a contact name and phone number of someone we can call.
Your answer
How did you hear about us?
If you were referred from an existing client, please let us know below so we can thank them!
Referral
If you were referred by a friend, please let us know who we can thank!
Your answer
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