Please Note: We will be closed on Thursday, November 28th and Friday, November 29th in observance of Thanksgiving!

New Client Registration Form

Name: Suffolk Animal Hospital
Address: 1232 Holland Road, Suffolk, VA, 23434, United States
Telephone: 757-539-1385
Price range: $

get started

Thank you for choosing us!

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 into providing optimal care for your pet(s). Please Note: All * sections are required.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare?

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Preferred method of contact? *

Primary Phone
Secondary Phone
Email
Text

Are you or your spouse Active Military? *

Pet Health History

Pet's Name *

Species (dog, cat, etc.) *

Breed (if known) *

Color/Markings *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Previous Veterinary Practice (if any) *

May we contact your previous veterinary practice to get a copy of your pet's records? *

Yes
No
Other

If 'Other', please specify:

Current Pet Insurance Company (if any)

Please use the following box to give us any other relevant information about your pet:

I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above-described pet. I assume full responsibility for all charges incurred for the card of this animal. I also understand that payment is due at the time services are rendered and that a deposit may be required for surgical treatment. *

I have read and accept this policy.

If an appointment is missed without at least 24 hours prior notice, there will be a $25 missed appointment fee. This missed appointment fee is for all appointments, including routine drop-off, bathing, and grooming appointments. *

I have read and accept this policy.

If your pet is not picked up within 30 minutes past our closing time, there is be a $25 late pick-up fee assessed. Over 30 minutes past closing and your pet will be considered an overnight guest, and boarding fees will be applied. *

I have read and accept this policy.

To cancel your pet’s boarding stay, we ask for notice 48 hours prior to their stay for routine bookings and 72 hours prior to their stay if over a holiday. If proper notice is not provided, there will be a $25 boarding cancellation fee. *

I have read and accept this policy.

I authorize my pet's pictures to be utilized in materials to represent Suffolk Animal Hospital, including but not limited to our Facebook page, Google +, and our website. *

I authorize the use of my pet's pictures.
I do not authorize the use of my pet's pictures.

Signature *

Clear Signature

Date *

Name

Schedule an Appointment

Suffolk Animal Hospital strives to provide quality veterinary care, with the goal of keeping your pets healthy and treating each customer as we would want to be treated.

Appointment

Questions?

Feel free to contact us. We proudly serve the pets of Suffolk, Windsor, Ivor, Chesapeake, VA, and beyond.

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Location

1232 Holland Road
Suffolk, VA 23434

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Contact

P: 757-539-1385
F: 757-539-8942
E: reception@suffolkanimalhospital.com

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Hours

Mon, Thu: 8 AM - 7 PM
Tue, Wed, Fri: 8 AM - 5 PM
Sat: 8 AM - 12 PM
Sun: Closed

Leave a Message

Use our contact form below, and a member of our team will get back to you shortly!

Name *

First

Last

Email *

Phone

How can we help you? *

Website