ANIC Client Registration

In order to help facilitate your check-in process, we offer our client registration form online (see below). Fill it out anytime prior to your appointment….just one less thing to worry about on your appointment day.

New Client Information
Note: This form is for registration at the Algodones, NM location ONLY.
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone*
Email*
Employer
Occupation*
New Patient Information
Pet's Name*
Pet Species*
Pet Breed (If known)*
Approximate Age*
Spayed or Neutered?*
Approximate Weight (in pounds)*
Vaccination Status
Pet Vaccinations Current?
Date of Last Rabies Vaccine*
List any medications (& dosage) your pet is currently taking*
Current Veterinarian Information
Name of your current veterinarian
Name of Veterinary Clinic where your pet is normally seen
Address of Veterinarian
Street Address Address Line 2 City State ZIP Code
We normally fax/email your regular veterinarian updates on your pet's condition. Please select one of the following options:*
- YES. Please fax/email my regular veterinarian updates on my pet's condition.
- NO. I DO NOT want any of my pet's records from The ANIC fax/emailed to my regular veterinarian.
Phone
This field is for validation purposes and should be left unchanged.

ANIC Client Registration

New Client Information

New Patient Information

Vaccination Status

Current Veterinarian Information