New Client
Application
Form

We are unfortunately unable to accept new clients at this time. Please check back in the fall!

Please allow 7-10 business days for a response from our team.

"*" indicates required fields

Step 1 of 11

Start Here to Join Our Family!

We are excited to pair with you to provide the best possible veterinary care for your pet. In order to achieve this goal, we require a minimum preventative standard of care to ensure the health of your pet. These requirements are to be performed at North Main Animal Hospital.

NMAH Standard of Care:*

In order to achieve this goal, we require a minimum preventative standard of care to ensure the health of your pet.

I agree to adhere to the NMAH Standard of Care below:

For dogs, this includes:
1. Annual exam by a veterinarian
2. Current Rabies vaccine (1 year or 3 year) and tag
3. Annual DHLPP/DHPP vaccine
4. Annual Heartworm Test
5. Heartworm prevention
6. Annual fecal exam for intestinal parasites

For cats, this includes:
1. Annual exam by a veterinarian
2. Current Rabies vaccine (1 year or 3 year) and tag
3. Annual FVRCP +/- FeLV vaccine
4. Annual fecal exam for intestinal parasites
5. Felv/FIV test (a one time test, usually performed as a kitten)

A second priority is the safety of our staff. Despite our best efforts for a stress free experience, a pet may need to be muzzled, sedated, or anesthetized in order to safely perform quality veterinary medicine. If concerns arise involving your pet, the situation and our recommendations will be discussed with you prior to proceeding.

Lastly, our goal at North Main Animal Hospital is to maintain a positive work environment. Our entire staff is expected to treat each other and all our clients in a polite professional manner. We expect the same treatment from our clients. Verbal abuse and bullying will not be tolerated in any form by staff or clientele at North Main Animal Hospital.

If these standards of care are not met, it may result in termination of your doctor/client/patient relationship with Main Animal Hospital. Your records will then be forwarded to the veterinary hospital of your choice.

1) Owner's Information

Name*

First

Phone*

Email*

Address*

Street Address City State ZIP Code

Do you need to add a Co-Owner?*

Yes

2) Co-Owner's Information

Name*

First

Phone*

Relationship To Owner*

Address*

Same as Owner?

Street Address City State ZIP Code

3) Reason For New Application

Reason for Application:*

Previous Veterinary Clinic Name:

Previous Veterinary Clinic Address:

Street Address City State ZIP Code

Referred By:

How many pets do you want to register?*

1st Pet's Information

1st Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

2nd Pet's Information

2nd Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

3rd Pet's Information

3rd Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

4th Pet's Information

4th Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

5th Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

6th Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

7th Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

8th Pet's Name:*

Pet Type:*

Cat

Dog

Pet's Gender:*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Obtained as:*

Puppy/Kitten

Adult

Date of Birth/Age:*

Pet's Breed:*

Color:*

Special Identification: (Tatoo/Microchip Number)

Date of Last Vaccine:

MM slash DD slash YYYY

Pet's Comfort Level at Veterinarian:*

Loves the Vet

Tolerates the Vet

Strongly Dislikes the Vet

Dislike Level*

Needs Muzzle

Needs Sedatives

List of Current Medications:

Current Heartworm Prevention:

Current Flea & Tick Prevention:

Food You Are Currently Feeding?

Any Allergies or Drug Reactions? If yes, what?

List of Current or Past Medical Conditions:

Please Use the Following Box To Give Us Any Other Relevant Information About Your Pet?

If available, please upload a digital copy of your Pet's previous health records.

Max. file size: 64 MB.

New Client
Application
Form

Start Here to Join Our Family!

1) Owner's Information

2) Co-Owner's Information

3) Reason For New Application

1st Pet's Information

2nd Pet's Information

3rd Pet's Information

4th Pet's Information

LEARN MORE

CONTACT US

New Client ApplicationForm

Start Here to Join Our Family!

1) Owner's Information

2) Co-Owner's Information

3) Reason For New Application

1st Pet's Information

2nd Pet's Information

3rd Pet's Information

4th Pet's Information

LEARN MORE

CONTACT US

New Client
Application
Form