New Client Registration - Fairfax Animal Hospital

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 Full Name

Confirm Email

Daytime Phone

Home Phone

Employer

Daytime Phone

Work Phone

Spouse / Other

Mailing Address

City

State

ZIP

Preferred Contact Method

Email Regular Mail / Postage

Pet's Name

Date of Birth (if known)

Species

Sex

Breed

Color/Markings

Specify problem(s), medications and dosages, if known:

Has your pet been treated for illness in the past year?

Yes No

Previous Veterinarian(s) where past records could be obtained:

I assume responsibility for all charges incurred in the care of this animal. I also understand these charges will be paid at the time of service or release and that deposit may be required for surgical treatment.

I agree to the Terms & Conditions of Fairfax Animal Hospital

Days :

Hours :

Minutes :

Seconds

Save $35 on Your Pet’s Next Visit

Healthy pets start with routine care. Schedule and complete your pet’s wellness exam by June 30 and enjoy $35 off.

Use code 35FL

Offer valid for appointments scheduled and completed by June 30, 2026.
Must mention code 35FL at scheduling. One offer per visit.

New Client Registration Form

Save $35 on Your Pet’s Next Visit