New Client Form

We are glad to have the opportunity to care for your pet. Our mission is to provide compassionate care by our dedicated experts. To ensure exceptional service, please fill out this form completely. Please email your pet's medical records or fax to 1-800-549-3114.
  • Co-Owner Information

  • Your Pet's Information

  • Date Format: MM slash DD slash YYYY
  • Second Pet (if applicable)

  • Date Format: MM slash DD slash YYYY
  • Referral Information

  • If it s a personal referral, please let us know their name! As a token of our appreciation, a $20.00 credit will be applied to their RVAH account for this referral.
  • This field is for validation purposes and should be left unchanged.