New Client Form

New Client Special

For a limited time, we are offering a New Client Special featuring $25 off your pet’s first exam! To receive the new client special, you must mention it when scheduling your appointment.

Our New Client Special is available for new clients only, one per family.

Welcome!

When you walk through the front door of Health & Harmony, our goal is to create a true partnership with you because your pet’s whole health – mind, body and soul – is our passion. Our veterinarians understand the importance of taking time to discuss all aspects of your pet’s care and lifestyle in a relaxed atmosphere.

At Health & Harmony, we differentiate ourselves from other practices by:

Partnering with local animal rescue organizations.
Prioritizing whole pet health with both holistic and conventional medical practices.
Building and maintaining a close-knit team that raises each other and our clients up.

To schedule an appointment, please fill out the form below and our team will reach out to you. If your pet needs to be seen as soon as possible, please give us a call at 614-360-3941.

"*" indicates required fields

Please select one:*

Please contact me to schedule an appointment

I have already scheduled an appointment

I have already had an appointment

Reason for the appointment*

Client Information

Primary Client Name*

First

Last

What are your preferred pronouns?*

She/Her/Hers

He/Him/His

They/Them/Theirs

Other

List Other

Cell Phone Number*

(we ask that your primary phone be a cell phone number as we will text appointment confirmations and reminders)

Alternate Phone Number*

Is this number for:

Home

Cell

Work

Address*

Street Address

Address Line 2

City

State

ZIP Code

Email*

Communication Preference*

Phone Call

Text

How did you find out about us?

Referred by family/friend

Referred by vet/trainer/daycare

Google / Yelp

Walked/drove by

Other

Who referred you, we’d love to thank them!

Please explain.

Ownership*

I am the sole owner/caregiver of the below listed pet(s)

I share ownership/responsibility of the below listed pet(s)

Secondary Client Information

Secondary Client Name

First

Last

What are your preferred pronouns?*

She/Her/Hers

He/Him/His

They/Them/Theirs

Other

List Other

Phone Number

Relationship to Primary Client

Patient Information

Pet's Name*

Species*

Cat

Dog

Breed*

Color*

Sex

Female

Spayed Female

Male

Neutered Male

Date of Birth*

Is the Date of Birth*

Exact

Estimated

How did you obtain your pet?

Which rescue/shelter*

If Other, please explain

Any known allergies or vaccine reactions?

Yes

Please Explain*

Do you have pet insurance?*

Yes

Has your pet been to a veterinarian before?*

Yes

Previous Clinic Name*

Upload pet records here

Max. file size: 50 MB.

Would you like to add a second pet?*

Yes

Second Pet Information

Pet's Name*

Species*

Cat

Dog

Breed*

Color*

Sex*

Female

Spayed Female

Male

Neutered Male

Date of Birth*

Is the Date of Birth*

Exact

Estimated

How did you obtain your pet?*

Which rescue/shelter*

If Other, please explain*

Any known allergies or vaccine reactions?*

Yes

Please Explain*

Do you have pet insurance?*

Yes

Has your pet been to a veterinarian before?*

Yes

Previous Clinic Name*

Upload pet records here

Max. file size: 50 MB.

Would you like to add a third pet?*

Yes

Third Pet Information

Pet's Name*

Species*

Cat

Dog

Breed*

Color*

Sex*

Female

Spayed Female

Male

Neutered Male

Date of Birth*

Is the Date of Birth*

Exact

Estimated

How did you obtain your pet?*

Which rescue/shelter*

If Other, please explain*

Any known allergies or vaccine reactions?*

Yes

Please Explain*

Do you have pet insurance?*

Yes

Has your pet been to a veterinarian before?*

Yes

Previous Clinic Name*

Upload pet records here

Max. file size: 50 MB.

Authorization

Photo Release – I authorize Health & Harmony Animal Hospital to take photographs of my pet and to copyright, use and publish them in print and/or electronically. This could include purposes such as social media, website and newsletters. My name will not be used but my pet’s name may or may not be included.*

Yes

Records Release – I authorize the release of my pet’s medical records to another facility (boarding/daycare/emergency hospital, etc) should they be requested.*

Yes

Signature*

Date*

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This field is for validation purposes and should be left unchanged.

New Client Special

Welcome!

Client Information

Secondary Client Information

Patient Information

Second Pet Information

Third Pet Information

Authorization

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care