New Clients

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New Client Registration Form

This form does not work properly in Safari right now. Please use Chrome or Edge. Sorry for the inconvenience.

This form is for NEW CLIENTS only. If you are an existing client and have an additional pet to register, please use our Additional Pet form instead.

* Indicates required field

Owner's Name *

First

Last

Email *

Mobile Phone Number *

Home Phone Number *

Work Phone Number *

Which is the best number to Contact You? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Spouse / Partner's Name *

First

Last

Spouse/ Partner Phone Number *

Emergency Contact Name *

First

Last

Relationship *

ER Contact Phone Number *

How Did You Hear About Us *

Pet's Name *

Sex *

Male Female

Species *

Dog Cat

Spayed / Neutered? *

Yes No Don't know

Breed *

Color / Markings *

Date of Birth (please estimate month/year if you aren't sure) *

Is your pet microchipped? *

Yes No Unsure

Microchip Number *

Please list all veterinary facilities previously visited *

Do you give City Veterinary Care permission to contact previous veterinary facilities for records pertaining to this patient? *

Yes No

Pet Insurance Company and Policy ID (if applicable) *

Upload a Picture of Your Pet *

Max file size: 20MB

By checking this box I confirm that I am 18 years of age or older. *

Agree

Submit

Office Hours

Monday 8:30am - 6:00pm
Tuesday 8:30am - 6:00pm
Wednesday 8:30am - 6:00pm
Thursday 8:30am - 6:00pm
Friday 8:30am - 6:00pm
Saturday 9:00am - 5:00pm
Sunday 9:00am - 5:00pm

Tech Hours

Book Your Tech Appointment!

Appointments

Appointment Hours

Request Appointment

In Case of Emergency

Contact Us

City Veterinary Care
220 West 72nd St
New York, NY 10023
(212) 799-7000
Fax (212) 799-7107
admin@cityvetcare.com

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Home
Services
- Hospital Tour
Team
New Clients
Contact
Education
Additional Pet Registration
New Page

New Client Registration FormThis form does not work properly in Safari right now. Please use Chrome or Edge. Sorry for the inconvenience.This form is for NEW CLIENTS only. If you are an existing client and have an additional pet to register, please use our Additional Pet form instead.

New Client Registration Form

This form does not work properly in Safari right now. Please use Chrome or Edge. Sorry for the inconvenience.

This form is for NEW CLIENTS only. If you are an existing client and have an additional pet to register, please use our Additional Pet form instead.