New Patient Registration Form

Please provide your contact information so Avon Animal Hospital can create your account and contact you to schedule your appointment.

Please enter one pet per row. Use the + button to add another pet so multiple pets can be included in the same registration.

New York State Office of Professions regulations prohibit us from releasing any information contained in your pet's medical record to any third party without your consent. The only exception is in the event of a biting incident or suspected rabies exposure. In those situations, we are REQUIRED by law to provide a copy of your pet's Rabies Vaccination Certificate to the appropriate public health authority. No other medical information will be released without your authorization.

I understand that I am responsible for the prompt payment of all charges resulting from my pet’s visit to Avon Animal Hospital. IN THE EVENT OF NON-PAYMENT, ANY OUTSTANDING BALANCE WILL BE SUBMITTED TO A COLLECTION SERVICE WHICH YOU AGREE TO REIMBURSE US THE FEES OF ANY COLLECTION AGENCY, WHICH MAY BE BASED ON A PERCENTAGE AT A MAXIMUM OF 25% OF THE DEBT, AND ALL COSTS AND EXPENSES, INCLUDING REASONABLE ATTORNEY FEES, WE INCUR IN SUCH COLLECTION EFFORTS. There is a $50.00 charge for a returned check.

I give permission for Avon Animal Hospital and Surgical Center to use pictures of my pet on social media and/or in clinic advertisements.

PAYMENT IS DUE AT TIME OF SERVICE Accepted payment types: Cash, Check, Discover, Mastercard, Visa, CareCredit, Scratchpay.