703-820-2557 [email protected]

Instructions

Step 1

To schedule an appointment, please call us at 703-820-2557 before you complete our online forms.

Step 2

Also download, print, sign, and bring this form with you to your first visit: Medical Appointment Consent Form

Step 3

Please complete the online registration form below.

Fairfax Animal Hospital – Pet Registration

New Client Registration Form

New Client Registration Form

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 Information

If different from Daytime Phone

Spouse / Other

Mailing Address

Address
City
State/Province
Zip/Postal

Pet Information

Additional Information

You indicated that you were referred by a Current Customer and we would like to thank them!

Terms & Conditions

Sending
Online Records and Pet Prescriptions

Manage Your Pet's Care From Your Phone

Message Our Team Directly, View Vaccine Records, Refill Prescriptions, and Schedule Appointments!

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