Name: East Atlanta Animal Clinic
Address: 461 Flat Shoals Ave SE Atlanta, Atlanta, GA, 30316, US
Telephone: 404-523-8765
Price range: $$

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.

If requesting an appointment, what is your desired date? (appointments are seen Monday through Friday only)*
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.

Please Note that we require a $25 deposit per pet for new client visits.

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 Name
Name*
First Last
Owner's Phone Numbers
Home Phone*
Work Phone
Mobile Phone
Owner's Address
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
COUNTY*
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
Pet Information
Pet's Name*
Species*
Breed (if known)*
Color*
Date of Birth or Age (if known)*
Sex*
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?
I understand that payment is due at the time of services. I accept that the clinic accepts cash, checks, Visa, Mastercard, American Express and Discover cards. I acknowledge and understand that for all checks used for payment (1) the clinic will need to have my current valid driver’s license presented at that time, (2) the clinic will process all checks electronically and (3) there will be a $35 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
Previous Vet Records
Drop files here or

New Client Registration Form

Owner's Name

Owner's Phone Numbers

Owner's Address

Co-owner's Name & Contact #

Pet Information

Location

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Hours of Operation

Contact