Fairfax Animal Hospital – Pet Registration

Thank you for choosing Fairfax Animal 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 the following information to help our team get to know you and your pet.

You may also download the form.  Please download, print, sign, and bring it with you to your first visit: New Client Form Download

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

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