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828-684-4244
 
5515 HENDERSONVILLE ROAD FLETCHER, NC 28732
 
AFTER HOURS EMERGENCY CLINICS
 
Mills River Animal Clinic

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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
Name*



First



Last


Address*



Street Address


Address Line 2


City


State / Province / Region


ZIP / Postal Code

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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*
DogCatRabbitFerretBirdReptile
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Neutered MaleSpayed FemaleMaleFemaleUnknown
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)


Date Format: MM slash DD slash 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


 












Δ


We Now Accept Scratchpay
We are now accepting Scratchpay to help your pets get the care they need.
Apply Now

We Now Accept CareCredit
 
We are now accepting CareCredit to help your pets get the care they need.
 Apply Now

Contact.
 
Phone: 828-684-4244
 
Email: hello@fletchervets.com
 
5515 Hendersonville Road

Fletcher, North Carolina 28732
 Make An Appointment
Hours
 
GENERAL PRACTICE & WELLNESS
 
Monday – Friday 7:30 AM to 5:00 PM

Saturday – Closed

Sunday – Closed
 
AFTER-HOURS URGENT CARE & EMERGENCY
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