Home
Contact
Blog
Pet Portal Login
Home Delivery
About Us
Our Practice
Our Team
Location & Hours
Employment Opportunities
New Clients
What To Expect
Take A Tour
New Client Registration
Existing Clients
New Client Registration
Add a New Pet Form
Request an Appointment
Contact Form
Canine Senior Wellness Form
Feline Senior Wellness Form
Services
Request an Appointment
Medical Services
Alternative Medicine
Wellness & Preventive Medicine
Nutritional Counseling
Palliative Care / Hospice
Surgery
My Pet
Request Services
Pet Info
Interactive Animal
Breed Info
Pet Health Articles
Videos
Pet Health Checker
Links
Home Delivery
Contact Us
About Us
Our Practice
Our Team
Location & Hours
Employment Opportunities
New Clients
What To Expect
Take A Tour
New Client Registration
Existing Clients
New Client Registration
Add a New Pet Form
Request an Appointment
Contact Form
Canine Senior Wellness Form
Feline Senior Wellness Form
Services
Request an Appointment
Medical Services
Alternative Medicine
Wellness & Preventive Medicine
Nutritional Counseling
Palliative Care / Hospice
Surgery
My Pet
Request Services
Pet Info
Interactive Animal
Breed Info
Pet Health Articles
Videos
Pet Health Checker
Links
Home Delivery
Contact Us
Add a New Pet Form
Congratulations on your new pet! We look forward to meeting this addition to your family! Thank you for continuing to choose our clinic for your pets' veterinary services. We are dedicated to maintaining the health of your pets and look forward to many more years together.
Please complete this form as fully as possible prior to your first appointment with your new pet. This will help expedite the registration process and give us valuable insight in providing optimal care for your pet. The required sections have a red * asterisk.
NOTE: If you have never been to East Atlanta Animal Clinic, please use the
New Client Registration Form
.
Do you need to make an appointment?
*
No, I already have an appointment.
No, I will call later to make an appointment.
Yes, please contact me to set up an appointment.
If requesting an appointment, what is your desired date? (appointments are seen Monday through Friday only)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Once we receive this form, we will contact you to confirm a date and time that is as close to your request as possible. If you have not heard from us within 24 hours, please contact the clinic by phone to confirm.
NOTE: If you need an appointment within the next two business days, please call the clinic at 404-523-8765.
Reason for Appointment (if applicable)
Owner's Information
Name
*
First
Last
Best Contact Phone #
*
Secondary Phone, if desired
Email
*
Enter Email
Confirm Email
Please use this area to give us any updates to your information. You can also include other relevant information about yourself or your family if desired.
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Breed (if known)
*
Color
*
Date of Birth or Age (if known)
*
Special Identification (tattoo, microchip, etc.)
Upload a photo of your pet
Accepted file types: jpg, gif, png, pdf, doc, docx.
Sex
*
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice (if any)
*
Previous Veterinarian (if any)
*
Date of last vaccines (if known)
What vaccines were given at this time?
Or, you can upload a photo or file.
Upload vaccine info
Accepted file types: jpg, gif, png, pdf, doc, docx.
Is your pet on heartworm and/or flea prevention?
*
Yes
No
Please list the brand(s) used and the date(s) last given
Is your pet on any other medication or supplement?
*
Yes
No
Please list the medication/supplement, amount given and frequency
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
Upload additional files
Accepted file types: jpg, gif, png, pdf, doc, docx.
Upload additional files
Accepted file types: jpg, gif, png, pdf, doc, docx.
I understand that payment is due at the time of services. We accept cash, Visa, Mastercard, American Express and Discover If you would like to write a check, we will need to have your driver’s license number. We run all checks electronically. There will be a $20 fee on all returned checks.
*
I agree
I understand that there is an exam fee that does not include the treatment of my pet. I assume responsibility for all charges incurred in the care of my pet. I also understand that these charges will be paid at the time of release and a deposit may be required on all hospitalized pets. I understand that I may request an estimate prior to treatment.
*
I agree
Photo/Video Release: Please indicate if you authorize EAAC to take photos and/or videos of your pet to keep on file. EAAC may use them in various venues including, but not limited to website, social media, brochures, etc.
*
Authorize Photo/Video Release
Decline Photo/Video Release
