Make Appointment

New Client Registration Form

Welcome to Mill Valley Pet Clinic!
Please fill out this form in its entirety to help us prepare for your upcoming visit.

Please note that we require New Client Registration Forms to be completed 24 hours PRIOR to your first appointment. If we do not receive this form 24 hours prior to your appointment, WE WILL NEED TO CANCEL AND RESCHEDULE YOUR APPOINTMENT.

Client Information

Pet Owner

Address

By providing your phone number, you are agreeing to receive calls and text messages regarding your pet's health and medical reminders from Mill Valley Pet Clinic. You can opt out at any time.

By providing your email address, you are agreeing to receive emails regarding your pet's health, medical reminders and news about Mill Valley Pet Clinic.

Is there a secondary owner or spouse we should add for this pet(s)?

Spouse/Secondary Owner

Pet Information

Please complete all information below.

Species
Sex
Is your pet spayed or neutered?
Has this pet been a patient of another veterinary clinic(s)?

Max. file size: 32 MB.

Do you have a second pet to add?

Second Pet Information

Please complete all information below.

Species
Sex
Is your pet spayed or neutered?
Has this pet been a patient of another veterinary clinic(s)?

Max. file size: 32 MB.

Do you have a third pet to add?

Third Pet Information

Please complete all information below.

Species
Sex
Is your pet spayed or neutered?
Has this pet been a patient of another veterinary clinic(s)?

Max. file size: 32 MB.

Social Media Release

Mill Valley Pet Clinic occasionally features client pets on our social media accounts. By opting in, you give your consent for your pet(s) to be featured. We will never post medical or case photos or information without additional consent from you.

Social Media Consent

Policy Confirmation

Policy Agreement
Consent to Treat