Please fill out our Pet Registration Form using one of the options below if your pet is a new patient at Gluckstadt Animal Hospital.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

Pet Registration Form

Patient History


Please check which vaccinations your pet has had within the last year:

Today's Visit

By submitting this form, I hereby authorize Gluckstadt Animal Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate.