New Clients

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
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
• Day-Time Phone*
• Evening Phone
• Mobile Phone
• Email*
  Enter Email Confirm Email

• Co-owner's Name & Contact #

• Name
  First Last
• Phone
• How did you find out about our practice?
  • Clinic Location
  • Personal Referral
  • Internet Search / Website
  • Clinic Sign
  • Other
• If Other, please specify:
• If Personal Referral, is there someone we can thank for this referral?
• Please use this area to give us any other relevant information about yourself or your family

• Pet Information

• Pet's Name*
• Species*
  DogCatRabbitFerretBirdReptile
• or if other species
• Breed (if known)
• Color
• Date of Birth or Age (if known)
• Special Identification (tattoo, microchip, etc.)
• Sex
  Neutered MaleSpayed FemaleMaleFemaleUnknown
• Previous Veterinary Practice (if any)
• Previous Veterinarian (if any)
• Is your pet on any medication or supplement?
  • Yes
  • No
• If Yes, please list the medication or supplement (please include strengths and frequencies)
  This information is VERY important and recommendations cannot be made safely without knowing current regimen, if a current medication is not listed, we cannot prevent interactions
• What food does your pet eat?
• Does your pet have allergies or drug reactions?
  • Yes
  • No
• If Yes, please list the allergies and reactions
• Are there any current or past medical conditions of which we should be aware?
  • Yes
  • No
• If Yes, please comment on the condition(s) and indicate if they are current or past conditions
• Please use the following box to give us any other relevant information about your pet
• File
  Upload History (Labwork etc)
• Consent
  We are a one doctor facility, we schedule our appointments so that each patient receives the right amount of time to be seen by Dr. Woods and staff. That is why it is very important that you keep your scheduled appointment with us, and arrive on time. If your schedule changes and you cannot keep your appointment, please contact us so that we may reschedule you, and accommodate those patients who are waiting for an appointment. As a courtesy to our office as well as to those patients who are waiting to schedule with Dr. Woods, please give us at least 24 hours notice. If you do not cancel or reschedule your appointment with at least 24 hours notice, we will assess your appointment history, and a requirement of prepayments for future appointments could be assigned as well as cancellation fees.
  I agree to the privacy policy.

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Welcome! Thank you for choosing Integrative Veterinary Health Center for your pet’s care.

We are dedicated to helping your pet achieve the highest quality of life.

Our team provides exceptional care while showing respect for you and your beloved companion.

Not computer savvy? No problem. Feel free to call us at 714-532-0755 to book an appointment and we’ll gather the registration information over the phone.

If you have any further questions, please call. We look forward to meeting you and your pets soon!