Appointment Information

Please select:

I know my appointment date and time.

My online appointment request is pending.

Not ready to schedule, but I want to become a client.

Date

Time

AM/PM

Client Information

Pet Owner Name (Primary Contact)(Required)

First

Last

Phone(Required)

Please Select

Would you like to receive text (SMS) messages from Big Rock Veterinary Hospital?

Co-owner Name (Secondary Contact)(Required)

First

Last

Phone

Please Select

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Email(Required)

Your privacy is important to us. Your email is used exclusively for communications from our hospital about your pet’s health.

How did you hear about us?(Required)

Please specify:

Former Veterinarian (to request previous medical history)

Patient Information

Have more than one pet? Click “Add Pet” to provide information about your whole four-legged family!

Pet 1

Name(Required)

Species(Required)

Sex

Date of Birth

Approx. Age(Required)

Breed(Required)

Color/Markings(Required)

Please list any chronic conditions (e.g. diabetes, autoimmune disease, etc.)

Medications/Supplements

Please include the name, dose, and frequency of the drug/supplement (e.g. Carprofen 25mg every 12 hours)

Do you have a second pet?(Required)

Yes

Pet 2

Name(Required)

Species(Required)

Sex

Date of Birth

Approx. Age(Required)

Breed(Required)

Color/Markings(Required)

Please list any chronic conditions (e.g. diabetes, autoimmune disease, etc.)

Medications/Supplements

Please include the name, dose, and frequency of the drug/supplement (e.g. Carprofen 25mg every 12 hours)

Photography Consent

We adore our patients, and love to share photos and stories about the wonderful pets we see every day.
May we feature your pet, too?

I hereby grant to Big Rock Veterinary Hospital, its representatives and employees, the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically.

I agree that Big Rock Veterinary Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

Authorization:

I allow Big Rock Veterinary Hospital to use images of my pet(s) and myself.

I allow Big Rock Veterinary Hospital to use images of my pet(s) ONLY.

I do not wish for images of myself OR my pets to be shared.

May we include your name with images used on our website or social media accounts?

Yes

Other

New Client Registration