New Client 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
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
MM
DD
YYYY
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet

Address
271 Johns Brook Ln
Keene Valley, NY 12943, USA

Call Us (518) 972-1774

Your Pet Is Our Family

High Peaks is a full-service veterinary medical facility, located in the Adirondack Mountains. The professional and courteous staff at High Peaks seeks to provide the best possible medical care, surgical care and dental care for their highly-valued patients.

Get To Know Us

Ready to become part of the
family at High Peaks?

Just fill out our quick online form!

New Client Form

Owner's Name

Co-owner's Name & Contact #

Pet Information

Your Pet Is Our Family

High Peaks is a full-service veterinary medical facility, located in the Adirondack Mountains. The professional and courteous staff at High Peaks seeks to provide the best possible medical care, surgical care and dental care for their highly-valued patients.

Ready to become part of the family at High Peaks?

Ready to become part of the
family at High Peaks?