New Client Information

New Client Registration Form

Thank you for choosing Robinson Animal 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 at least 48 hours prior to your requested initial appointment date. This will help expedite the registration process, allow us to accomodate your appointment request, and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

If you would like for us to have prior health records, please request that they be faxed to us at (423) 631-0115.

If you do not receive confirmation of your appointment within 24 hours of submission, please contact your requested location.

Appointments are scheduled between 9:00 and 11:30AM and again between 2:00 and 5:30 on weekdays. Watauga Avenue accepts Saturday appointments between 9:00AM and 12:30PM on Saturdays. North Johnson City accepts appointments between 9:00 and 11:30AM on Saturday, and is available for walk-ins in the afternoon and on Sunday.

This form is for medical appointments only and should only be used for requesting appointments that will take place at least two full business days after submission of this form. Therefore it is not for an emergency situation, injured, or critically ill pet. Please call your preferred location, in those instances

For grooming requests, please call your preferred location. For boarding requests, please call 423-928-1616.

We look forward to seeing you and are anxious to care for your precious pet!

Owner's Name
Name*
First Last
Spouse or Co-Owner
Name
First Last
Address
Address*
Street Address Address Line 2 City State ZIP Code
Preferred Phone*
Mobile Phone*
Email*
Enter Email Confirm Email
Is there anyone else who might be responsible for your pet on occasion, such as a pet sitter or groomer? If so, please provide a name.
How did you find out about our practice?*
- Drove by
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper Advertising/ Print Media
If Personal Referral, who may we thank for this referral?
Pet Information
Pet's Name*
Species*
Other species? Please indicate
Sex*
Breed (if known)*
Color*
Date of Birth or approximate age*
Special identifications such as tatoo or microchip?*
When was your pet last seen by a veterinarian?*
If you would like to for us to obtain prior health records, please provide contact information.
Date of Last Vaccinations*
What vaccines were given at this time*
Is your pet on heartworm prevention?*
If yes, please supply brand name
Is your pet on flea prevention?*
If yes, please supply brand name
Is your pet on any medication or supplement?*
If Yes, please list any medications or supplements
Does your pet have any known allergies or drug reactions?*
If Yes, please list the allergies and reactions
Are there any known current or past conditions of which we should be aware?*
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Our pet was*
Out Pet is*
Additional information that might assist in providing the best care for your pet
Request an Appointment
Which location would you prefer?
With whom do you request this service?
Preferred Date*
Date Format: MM slash DD slash YYYY

Must be at least 24 hours after submission of this request. Otherwise, please call your preferred location.
Preferred Time*

: HH

MM

No appointments are available before 9AM. No appointments are available between 12PM and 1:30PM. The latest morning appointment is 11:30AM and the earliest afternoon appointment is 2PM.
Alernate Preferred Date*
Date Format: MM slash DD slash YYYY
Reason for your appointment
Please confirm my appointment by:*

New Client Registration Form

Owner's Name
Name*
First Last
Spouse or Co-Owner
Name
First Last
Address
Address*
Street Address Address Line 2 City State ZIP Code
Preferred Phone*
Mobile Phone*
Email*
Enter Email Confirm Email
Is there anyone else who might be responsible for your pet on occasion, such as a pet sitter or groomer? If so, please provide a name.
How did you find out about our practice?*
- Drove by
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper Advertising/ Print Media
If Personal Referral, who may we thank for this referral?
Pet Information
Pet's Name*
Species*
Other species? Please indicate
Sex*
Breed (if known)*
Color*
Date of Birth or approximate age*
Special identifications such as tatoo or microchip?*
When was your pet last seen by a veterinarian?*
If you would like to for us to obtain prior health records, please provide contact information.
Date of Last Vaccinations*
What vaccines were given at this time*
Is your pet on heartworm prevention?*
If yes, please supply brand name
Is your pet on flea prevention?*
If yes, please supply brand name
Is your pet on any medication or supplement?*
If Yes, please list any medications or supplements
Does your pet have any known allergies or drug reactions?*
If Yes, please list the allergies and reactions
Are there any known current or past conditions of which we should be aware?*
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Our pet was*
Out Pet is*
Additional information that might assist in providing the best care for your pet
Request an Appointment
Which location would you prefer?
With whom do you request this service?
Preferred Date*
Date Format: MM slash DD slash YYYY

Must be at least 24 hours after submission of this request. Otherwise, please call your preferred location.
Preferred Time*

: HH

MM

No appointments are available before 9AM. No appointments are available between 12PM and 1:30PM. The latest morning appointment is 11:30AM and the earliest afternoon appointment is 2PM.
Alernate Preferred Date*
Date Format: MM slash DD slash YYYY
Reason for your appointment
Please confirm my appointment by:*

New Client Information

New Client Registration Form

Owner's Name

Spouse or Co-Owner

Address

Pet Information

Request an Appointment

New Client Registration Form

Owner's Name

Spouse or Co-Owner

Address

Pet Information

Request an Appointment

Locations

Robinson Animal Hospital – North Johnson City

Robinson Animal Hospital – Downtown

Robinson Animal Hospital – Gray

New Client Information

New Client Registration Form

Owner's Name

Spouse or Co-Owner

Address

Pet Information

Request an Appointment

New Client Registration Form

Owner's Name

Spouse or Co-Owner

Address

Pet Information

Request an Appointment

Share

Locations

Robinson Animal Hospital – North Johnson City

Robinson Animal Hospital – Downtown

Robinson Animal Hospital – Gray