Animal Medical Center / New Client

Animal Medical Center
Your Pet's Second Best Friend


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New Client Registration & Appointment Request

Welcome to Animal Medical Center. We appreciate the opportunity to serve you and your pets.

For general information about our practice, please review our Welcome Packet (.pdf). This form packet is provided for your convenience if you wish to print out basic information about our hospital.

Welcome
Hours, Appointments, Emergencies & Boarding
Charity Care
Adoption Program
Financial Policy

If you are a new client and would like to make an appointment, you can help us expedite your check in by submitting the electronic form below. Please complete it as best you can. We can complete any missing information or add any additional pets at check in or over the phone.

We appreciate the opportunity to serve you and we look forward to meeting you and your pets.

If your pet has received veterinary care elsewhere in the past, please try to bring a copy of his medical records to your first appointment or ask your prior veterinarian to fax us the records. Most veterinarians are happy to fax records -- just give them our phone number and they will take care of the rest. If you need our assistance in getting records, just let us know and we'll help!

Don't forget to check for your welcome savings on our Special Offers page!

Form - New Client Registration

Name (required)
First Name (required)	Last Name (required)

Secondary Name (Spouse)
First Name	Last Name

Do you have an appointment scheduled already? (required)
(Select One)
Not yet, please call me at any of my numbers to schedule
Not yet, please call me at home to schedule
Not yet, please call me at work to schedule
Not yet, please call me on my cell to schedule
Not yet, I plan to call this week
Yes

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

E-Mail Address :

Primary Phone (required)
Phone Type	Phone Number (required)

Other Phone
Phone Type	Phone Number

Other Phone
Phone Type	Phone Number

How were you referred to AMC?

How did you first learn of AMC? (required)
(Select One)
Referred by a friend
AMC website or web search engine
Yellow Pages
Saw Sign
Mountain Lair Website
Newspaper Ad
Other

If you were referred by an AMC client, please give us their name(s) so we can thank them.

If you list "Other", please describe how you found AMC.

Your Pet

Pet's Name (required)

Species (required)
(Select One)
cat
dog
other

If your pet species is "other", what is it (amazon grey parrot, gerbil, etc.)?

Breed? (required)

Sex? (required)
(Select One)
unknown
neutered male
intact male
spayed female
intact female

Color? (required)

Birth Date or Age? (required)

Veterinary History (required)
(Select One)
This will be my pet's first visit to a veterinarian.
My pet has had prior veterinary care and I will be able to bring copies of his medical records with me to our appointment.
My pet has had prior veterinary care but I don't have his records yet. Please contact me to help me get the records faxed or mailed to AMC.
My pet may have had prior veterinary care but I don't have records and I don't know what veterinarian(s) provided the care.

Additional Information About My Pet (medical conditions, etc.)

Your Appointment

Please tell us the reason for your pets visit: (required)

What appointment time(s) or day(s) work best for you?

Additional Comments or Requests

Animal Medical Center
460 Hartman Run Road
Morgantown, WV 26505
(304) 292-0126

Your Pet's Second Best Friend