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.

Cancelation policy

Deposits are required to reserve an appointment slot for all new clients and pets with an annual exam that is overdue. At the time of the appointment, this deposit will be used to cover the examination fee. Cancelations must be made three hours prior to appointment time. The deposit will be applied to the rescheduled appointment. Failure to call three hours prior to appointment will result in forfeiture of deposit. In order to be fully refunded, a 24-hour notice must be given prior to the scheduled appointment cancelation.

Owner's Name
Client Code of Conduct*
Green Acres Pet Center seeks to continually provide a welcoming and safe environment which ensures trust and respect for all people and pets.

We have a zero-tolerance policy for the following behavior:

Verbal abuse, malicious or harmful statements about others, profanity or disrespect directed at a person or pet
Any form of harassment
Discriminatory comments and/or actions
Intimidation tactics and/or threats
Allowing your pet to intimidate or threaten a person or another pet
Public disclosure of another’s private information
Suspicion of being under the influence of alcohol or behavior-altering drugs
Failure to comply with requests from our staff, including leashing/restraining your pet
In the event that your behavior is problematic, we reserve the right to discontinue services immediately.

This policy is strictly enforced and non-compliance will result in corrective measures being taken, which may include termination of veterinary care at Green Acres Pet Center, being asked to leave the property and the potential of involvement by law enforcement.

Thank you for your cooperation and understanding.
I have read and agree to the Client Code of Conduct
Name*
First Last
Date of birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Physical address (if different from mailing address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What is your drivers license number*
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Preferred method of communication
- Phone Call
- Text Message
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- 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*
Other
or if other species
Breed (if known)*
Color*
Date of Birth or Age (if known)*
Special Identification (tattoo, microchip, etc.)
Sex*
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known) dd/mm/yyyy
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
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
Are you eligible for any of the following discounts?
- Senior Discount (Over 60 years)
- Veteran/Active Military
We are full payment at the time of service, do you agree to pay in full?
- Yes
- No
Do you confirm that you are over 18 years of age?
- Yes
- No
How would you like to pay?
- Cash
- Check
- Credit Card
- Care Credit/Scratch Pay
Do you already have a scheduled appointment? If so, what is the date and time?
- Yes
- No
If so, what is the date and time?
If not, choose a date.
Date Format: MM slash DD slash YYYY
What time works best for you?
Date Format: MM slash DD slash YYYY
Green Acres Pet Center occasionally shares photos on our social media outlets of happy pets. Do we have your consent to share your pet's first name and photo on our hospital Facebook and Instagram?
- Yes
- No

Welcome To Green Acres Pet Center

We look forward to seeing you at our Pet Center soon and welcoming you at our place.

868 Green Acres Dr.
Twin Falls, ID 83301

Office hours 7:30 a.m.-6:00 p.m.

Doctor’s hours 8:00 a.m.-5:15 p.m.

Appointments by Request

Call Us: 1-208-734-2711

Green Acres Pet Center has been serving the greater Magic Valley for over 40 years

We emphasize modern veterinary medicine techniques and procedures, with special interest in dermatology, ophthalmology, dentistry, internal medicine, as well as canine reproduction. Contact us for same day appointments!

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