Forest Home Animal Clinic
"Providing comprehensive health care for your family pet."


414.425.2340
Call us today for all of your pet's health care needs!
414.425.2340

Recommend us to your friends on FaceBook.

Pet Portal
What is a Pet Portal?


Click Here To Access Our FaceBook Page!


An Update on Erin's Condition


Health Alerts!
Statewide Distemper Outbreaks
Have You Given Your Dog The Gift Of Protection?


Stay & Play Group
We meet Tuesday evenings, Saturday & Sunday afternoons. Are you ready to join the fun?


Current Specials & Coupons


Free Puppy Jump Start
Remember, our Puppy Jump Start class is always free to our clients.


2011 Biggest Loser Challenge
And, the winner is...

Forest Home Animal Clinic
11222 West Forest Home Avenue
Franklin, Wisconsin 53132
Phone: (414)425-2340
Fax: (414)425-4762

Hours of Operation
Monday - Friday
8:00 AM to 6:00 PM
Saturday 8:00 AM to Noon

Click here for BBB Business Review

Wisconsin Veterinary Medical Association




New Client Registration Form

Please call our clinic at (414)425-2340 to make an appointment.
By filling out this form, and submitting it ahead of time, you won't need to fill out the New Client Registration Form when you check your pet in with our reception staff.

Thank you. We look forward to meeting your pet.

Form - New Client

Date

Name (required)
First Name (required)
Last Name (required)
Home (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Employer

Employer's Address
Street Address
City
State/Province
Zip/Postal Code
,
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
Emergency Contact (required)
First Name (required)
Last Name (required)
Emergency Contact's Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months (required)

Type of Pet (required) :
Breed: (required)

Sex: (required)
Male
Female

Neutered/Spayed (required)
Neutered
Spayed

Where did you get your pet from? (required)
Friend
Breeder
Pet Shop
Humane Society
Other

Are your pet's vaccine's current? (required)
Yes
No

If your pet is on any medications, please list below: (required)

Do you have your pet's Medical records? (required)
Yes
No

Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Would you like us to call you for your appointment?
Reasons or conditions that prompted your visit?

Please check any symptoms or problems you've noticed with your pet:
No Problems
Appetite Loss
Behavioral Changes
Breathing Problems
Depression
Diarrhea
Eye Disorders
Gagging
Gums Bleeding
Limping
Scratching
Shaking Head
Sneezing
Thirst
Urination Increase or Problems
Vomiting
Weakness
Pet's History (check all that your pet has received)
Distemper
Parvovirus (Dog)
Rabies (Dog/Cat)
Feline Leukemia Test
Dental Cleaning
FVRCP (Infectious Disease-Cat)
Special requests or conditions?

How did you hear about our practice? (required)
A Client
Website
Add in the newspaper
Walk-In
Other

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Forest Home Animal Clinic and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Forest Home Animal Clinic's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and - (required)
I Agree
I Disagree


The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.