Online Forms

Thank you for choosing the Bernardsville Animal Hospital to meet the needs of you and your family pet. For your upcoming visit at our clinic, jump ahead in the registration process and download our Client Registration Form.

Please feel free to complete the form at your leisure and bring it with you on the day of your scheduled appointment. Please also bring with you any of your pet's medical records so that we can make a copy for our records.

For our New patients, it is imperative to get a very detailed history prior to your visit to the clinic, please select the appropriate form below or call us and a Nurse will assist you in the completion of your form:

For Dog + Cat Patients
Dog + Cat New Client Form

For Avian Patients
Avian New Client Form

For Reptilian Patients
Reptilian New Client Form

For Exotic Companion Animal Patients
Exotic Companion Animal New Client Form

Last Name*
First Name*
Address*
City*
Zipcode*
Primary Phone*
Phone Type*
Secondary Phone
Secondary Phone Type
Email*
# of Children At Home
# of Other Pets At Home
Do you have Pet Insurance?
How did you hear about our hospital?
Enter your Individual Referral (someone we may thank)
Pet's Name
Species*
Breed*
Date of Birth

Date Format: MM slash DD slash YYYY
Color*
Sex*
Spayed/Neutered*
Where Obtained?
Pet's Name
Species*
Breed*
Date of Birth

Date Format: MM slash DD slash YYYY
Color*
Sex*
Spayed/Neutered*
Where Obtained?
Pet's Name
Species*
Breed*
Date of Birth

Date Format: MM slash DD slash YYYY
Color*
Sex*
Spayed/Neutered*
Where Obtained?
What hospital was your pet last vaccinated or treated
City, State
Any Previous Serious illnesses or surgeries?
Any allergies to vaccination or medications?
Is your pet on any special diets or medications?
NOTIFICATION / AUTHORIZATION: TO PREVENT THE SPREAD OF INFECTIOUS DISEASES AND PARASITES, HOSPITALIZED AND BOARDED ANIMALS MUST BE CURRENT ON ALL VACCINES AND FREE OF INTERNAL AND EXTERNAL PARASITES. I AUTHORIZE THE BERNARDSVILLE ANIMAL HOSPITAL TO PROVIDE VACCINES AND PARASITE CONTROL AS NEEDED FOR MY PET. I AM FINANCIALLY RESPONSIBLE FOR THE PATIENT(S) DESCRIBED ABOVE AND AGREE TO PAY ALL FEES INCURRED. I UNDERSTAND THAT ANY MEDICAL OR SURGICAL PROCEDURE IS ASSOCIATED WITH SOME RISK AND THAT IT IS NOT POSSIBLE TO GUARANTEE THE SUCCESSFUL OUTCOME OF ANY SUCH PROCEDURE. THIS AGREEMENT IS IN FORCE INDEFINITELY FROM THIS DATE UNLESS I NOTIFY BERNARDSVILLE ANIMAL HOSPITAL IN WRITING TO THE CONTRARY.*
I GIVE MY AUTHORIZATION
- Yes
- No
I VERIFY THAT THE ABOVE INFORMATION IS CORRECT*
- Yes
- No
Today's Date*

Date Format: MM slash DD slash YYYY
CAPTCHA
Email

This field is for validation purposes and should be left unchanged.