New Client Registration Form

Welcome!

Thank You For Choosing Allentown Animal Clinic

If you are scheduled for your first appointment with us, please fill out the form below and we will be in contact with you shortly!

First Name
Please enter your first name.
Last Name
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Phone
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Email
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Street Address
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City
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State
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Zip Code
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Emergency Contact Name
Please enter your emergency contact.
Emergency ContactPhone
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Date
Please enter the date.
Pet's Name
Please enter your pet's name.
Species
Please enter your pet's species.
Breed
Please enter your pet's breed.
Age
Please enter your pet's age.
Previous Veterinarian
Please enter your previous veterinarian.
Is your pet male or female?
Please indicate whether your pet is male or female.
Is your pet neutered/spayed?
Please indicate whether your pet is neutered/spayed.
How did you learn about our hospital? Local shelter/rescue, Facebook, Online search, Referral, Drove by, Other
Please enter a message.

If you were referred by someone let us know who it is so we can make sure to thank them. (Please include first and last name)

Get Your Pet the care they need.

See our hours and schedule an appointment today!

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Pet Information and Stories

“Expected a crazy bill because of the animal and was wonderfully surprised at how reasonable the bill was for all the services I received”
- Kristen
“Very trustworthy place, detail-oriented, and truly care about your pets.”
- Haley P.
“I'm blessed to have them to care for my pets' health.”
- Iynne R.