New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

  • Owner's Name

  • Emergency Contact

  • Co-owner's Name & Contact #

  • Pet Information

  • Date Format: MM slash DD slash YYYY
  • I hereby authorize Town & Country Vet and the Pleasanton Pet Hotel to take photos of my pet(s) and post any and all photos taken to any and all social media platforms
  • I hereby authorize the Veterinarian to examine, prescribe for, or treat the above described pet(s). I assume all responsibility for all charges incurred in the care of my animal(s). I also understand that all professional fees are due at the time services are rendered. We accept Visa, Mastercard, Discover, Cash, or Care Credit.