American Vet - New Client Registration

American Veterinary Clinic

Al Falah Street
Abu Dhabi - UAE, BC PO BOX 31051

(971)665-5044

www.americanvet.ae

New Client Registration

This won't take long...

This form will allow us to register you and your pet in our medical system prior to your appointment.

Please bring your pet's vaccination records and any pertinent medical records with you to your appointment.

Thank you for choosing the American Veterinary Clinic.

New Client

Name + Email (required)

First Name (required)	Last Name (required)

E-Mail Address (required) :

Phone Number (please include all 10 digits for mobile numbers) *(required)*
Phone Type	Phone Number (required)

Alternate Phone
Phone Type	Phone Number

Pet's Name

Species: (required)

dog
cat
bird
other

Breed:

Pet's Date of Birth (mm/dd/yy) - approximate age is ok.

Sex:

male
female
I'm not sure

Is your pet sterilized? (neutered for males/spayed for females)

Yes
No
I'm not sure

Description / Color:

Reason for your visit?

If you do not already have an appointment, would you like us to call you to schedule an appointment? (required)

yes
no

Other comments:

Please list additional pets here:

Please Read:
I understand that I am responsible for any charges incurred while my pet is in the care of the American Veterinary Clinic and that charges are due and payable at the time of service.

I have read the above statement and agree to the terms outlined. (required)

Agree

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American Veterinary Clinic

tel: 00971 2 6655044

emergency: 050 6151711

Opening Hours:

Sunday 7:30am-6:30pm

Monday 7:30am-8:00pm

Tuesday 7:30am-6:30pm

Wednesday 7:30am-8:00pm

Thursday 7:30am-6:30pm

Friday 8:00am-4:00pm

Saturday Closed

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