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Welcome!

We are excited to meet you during your first appointment!

To ensure your information is correctly logged in our system to secure your appointment, please fill out our new client form below.

New Client Form

Human Information

Pet Owner's First Name(Required)

Pet Owner's Last Name(Required)

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Primary Phone Number(Required)

Please enter a valid phone number.

Primary Email for Communication(Required)

[email protected]

Spouse/Partner's First Name

Spouse/Partner's Last Name

Spouse/Partner's Phone Number

Please enter a valid phone number.

How did you hear about Riverview?(Required)

Pet Information

Pet's First Name(Required)

Pet's Preferred Last Name(Required)

Species(Required)

Canine

Feline

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Pet's Birthdate or Best Approximation(Required)

Breed and Color(Required)

Microchip Identification Number (If Known)

Known Medical Conditions (Allergies, Drug Reactions, Heart Conditions, etc.)(Required)

Previous Medical Records (If you do not have them)

Medical Records (If you have them)

Max. file size: 50 MB.

Please upload vaccine records, previous vet records, emergency visit summaries, etc.

Other Information

Do you have other pets? If so, what kind and how many?(Required)

Do we have your permission to share pictures of your pet on our social media?(Required)

Yes

By signing below, I authorize release of vaccine and medical records by Riverview Animal Hospital to third parties. I must contact Riverview Animal Hospital to void this medical release.(Required)

I understand that all fees are due when services are rendered. I may pay with cash, check, major credit card, Care Credit, or Scratchpay. There will be a charge on all returned checks in addition to fees charged by collection service. There will be a $5 service charge monthly for bills over 30 days past due. Should my account be referred to an independent collection agency, I understand that I am responsible for any additional cost such as collection fees, attorney fees and court costs. By signing my name below, I acknowledge that this is a representation of my electronic signature.(Required)

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641 N. Market Street,
Chattanooga, TN 37405

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