Online Store
Pet Portal
Hills to Home Registration
Hills to Home Login

Online Store

PET PORTAL

CALL FOR APPOINTMENT

(616) 866-9589

Rockford Animal Hospital

Home
Services
Pet Health
Team
Contact

CALL FOR APPOINTMENT

(616) 866-9589

FORMS

New Client Registration Form

Thank you for giving us the opportunity to care for your pet. To ensure the best care possible, please take the time to fill in this form completely.

Step 1 of 3

33%

Owner Name*
First Last
Please check if you are an existing or returning client
- Please check if you are an existing or returning client
Drivers License Number*
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone*
Cell Phone
Email address*
Enter Email Confirm Email

By providing us with your email address, we will send you reminders for your pet and appointments, newsletters and you will have access to your pet portal. *Your email will never be sold or passed on.
Hidden
Work Phone
Hidden
Place of Employment
Co-Owner Name
First Last
In case of Emergency, call (name)
Emergency Phone
Reason for your first visit:
- New to the area
- Need a new veterinarian
- New puppy or kitten exam
- Medical problem
- Spay or neuter
- Dental procedure
How did you find out about our practice?
- Social Media
- Internet Search / Website
- Outdoor Sign
- Friend/Family Referral
- Doctor Referral
Doctor Referral

AUTHORIZATION
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet(s). I assume all responsibility for all charges incurred in the care of the pet(s). I also understand that ALL PROFESSIONAL FEES ARE DUE AT TIME SERVICES ARE RENDERED. There will be a $25.00 fee on all returned checks.*
- Yes
- No
*By providing us with your e-mail address, you give us permission to send you communications such as newsletters, reminders for healthcare coming due, appointments and upcoming events. Your e-mail will never be sold or passed on.*
- Yes
- No
I hereby grant Rockford Animal Hospital permission to use any photographs and videos taken of myself or my pet, in any or all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become your property and will not be returned. I hereby authorize to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing your programs or for any other lawful purpose. In addition, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby release rights to all claims, demands, and causes to action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have by reason of this authorization. In signing this consent, I give authorization to use my name and my pet’s name and information as printed below.*
- Yes
- No
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Δ

AFTER HOURS EMERGENCY CARE

Hours of Operation

Monday 8:00am – 5:00pm
Tuesday 8:00am – 5:00pm
Wednesday 8:00am – 5:00pm
Thursday 8:00am – 5:00pm
Friday 8:00am – 5:00pm
Saturday Closed
Sunday Closed

Contact

616-866-9589

Email US

PET PORTAL LOGIN

Quick Links

Home
Services
Online Store
Pet Health
Hills to Home Registration
Hills to Home Login
About Us
Resources & Links
FAQ's
Emergency Care
Contact Us

FORMS

New Client Registration Form
Prescription Refill Request Form

cat friendly practice

ROCKFORD ANIMAL HOSPITAL
9937 Northland Drive NE
Rockford, Michigan 49341

© Copyright 2024. Rockford Animal Hospital. All Rights Reserved. Privacy Policy || Website developed by: VanDenBerg Web + Creative

Accessibility by WAH