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Animal Kingdom Pet Hospital 
 
New Clients
 
About Us 
 
Our Doctors
 
Our Team
 
Online Forms
 
Services
 
My Pet 
 
Profile
 
Medical Records
 
Request Services
 
Customer Satisfaction Survey
 
Pet Health 
 
Interactive Animal
 
Pet Health Checker
 
Pet Health Library
 
Breed Info
 
Videos
 
Contact Us
 
 
Online Pharmacy
 


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


 












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Animal Ark

Contact
3024 W 12th St

Erie, PA 16505
 
Ph: (814) 838-7387

Fax: (814) 835-2034
 
Hours
Monday – Friday:

7:30am to 8pm
 
Saturday:

7:30am to 2pm

Animal Kingdom

Contact
2222 E 38th St

Erie, PA 16510
 
Ph: (814) 825-0463
 
Hours
Monday – Friday:

7:30am to 7pm
 
Saturday:

7:30am to 2pm

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