New Client Registration Form – Highlands Ranch Animal Clinic

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New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Owner's Name
Name*
First Last
Spouse
First Last
Date
Date Format: MM slash DD slash YYYY
Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone
Cell Phone
Best Phone*
Drivers License #
Email*
Enter Email Confirm Email
In case we need to reach you at work:
Employer
Work Phone
Spouse's Employer
Work Phone
Pet Information
Pet's Name*
Species*
Breed (if known)
Date of Birth
Sex*
Do you have pet insurance*
- Yes
- No
If not, are you interested in pet insurance information?
- Yes
- No
Would you like to add another pet?
- Yes
- No
Second Pet Information
Pet's Name*
Species*
Breed (if known)
Date of Birth
Sex*
Do you have pet insurance*
- Yes
- No
If not, are you interested in pet insurance information?
- Yes
- No
Each patient we have the privilege to serve is entitled to, and will receive, the best care we can provide. In order to maintain a responsible and respected relationship, we must require you to honor our payment policy of cash, check, visa, mastercard, discover, american express, or carecredit. FULL PAYMENT IS DUE AT THE TIME SERVICES ARE RENDERED.
Consent*
I authorize this clinic to treat the above-mentioned animal(s), or any additional animals I may present, and agree to be responsible for all associated costs. (Must be 18 years of age or older.)
Date*
Date Format: MM slash DD slash YYYY
We appreciate your selection of Highlands Ranch Animal Clinic for your pet's care and look forward to a long-lasting relationship with you and your pets.
How did you hear about us?
- Referral
- Web site
- In the area
If this was a referral, may we thank them?
Name
Phone

Connect with us

Address

38 W. Springer Dr.
Highlands Ranch, CO 80129

Contact

(303) 791-2525
HRAC@HRanimalclinic.com

Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 6 pm
Thu: 8 am – 6 pm
Fri: 8 am – 6 pm
Sat: 8 am – 12 pm
Sun: Closed

Connect
with us

Address

38 W. Springer Dr.
Highlands Ranch, CO 80129

Contact

(303) 791-2525
HRAC@HRanimalclinic.com

Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 6 pm
Thu: 8 am – 6 pm
Fri: 8 am – 6 pm
Sat: 8 am – 12 pm
Sun: Closed

© 2026 Highlands Ranch Animal Clinic.
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Home
About Us
- Team
- Careers
New Clients
- New Client Registration Form
Services
Pet Health
Contact
- Prescription Refill and Food Order Request Form

facebook