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(973) 283-5023
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instagram

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New Client Form

Save time during your first appointment! Complete your required new client form online before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about Bark Avenue Veterinary Services? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Coat Color *

Birth date or Age *

Diet and Environment

What food does your pet currently eat? *

Amount & Frequency? *

Is your pet on any dietary supplements? *

Yes
No

Does your pet consume table/people food? *

Yes
No

Is your pet primarily indoor or outdoor? *

Indoor
Outdoor

Are there any other animals in the household? *

Yes
No

Do you have your pet groomed or boarded outside of your home? *

Yes
No

Do you travel outside of New Jersey with your pet? *

Yes
No

Past History

Has your pet had any prior illnesses, accidents, or surgeries *

Yes
No
Unknown

Is your pet aggressive or fearful around strangers? *

Yes
No
Unknown

Is your pet on heartworm, flea/tick preventatives? *

Yes
No

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications? *

Yes
No
Unknown

Has your pet ever had a reaction to any vaccines? *

Yes
No

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Birth date or Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

We love our patients and enjoy posting on our social media, follow us at @barkavenuevet. We want to use your pet's picture at some point in a post or story. Do you give us permission to use your pet's picture, whether in a direct post about them and their visit or indirectly as background footage? *

I have read and accept the financial policy.

Message

92 Route 23 Unit B
Riverdale, NJ 07457



(973) 283-5023
riverdale@barkave.vet

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Hours

Monday: 9AM to 5 PM
Tuesday & Wednesday: Closed
Thursday: 10AM to 5PM
Friday & Saturday: 12PM to 10PM
Sunday: 8AM to 12 PM
Holiday Closures: Closed on major holidays

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