Highlands Veterinary Center

New Client Form

We look forward to seeing you soon! Please use the form below to request an appointment online. If you need immediate assistance, please call us directly at 757-549-8609.

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Register New Patient/Client Form Online!

Thank you for choosing Highlands Veterinary Center for your pet care needs. Please fill out the New Client Registration form to help us prepare for your visit.

Client Information

Name *

First

Last

Alternative Name

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Contact Method *

Phone Call
Text
Email

How did you hear about our clinic?

Do we have permission to use your pets photo on Highlands Veterinary Center's website, social media, publications and software? *

Patient Information

Pet's Name *

Species *

Dog
Cat
Rabbit
Guinea Pig
Other Small Mammal

If other, please specify: *

Breed *

Gender *

Male
Neutered Male
Female
Spayed Female

Age/Birthdate

Coat Color

Microchip #

(If Relevant)

Primary Reason for Visit *

Diet (Brand, Wet/Dry, etc.)

Appetite

Urination (Urinating more, urinating less, normal)

Water Consumption (Drinking more, drinking less, normal)

Coughing/Sneezing

Vomiting/Diarrhea

Activity/Lifestyle

Indoor/Outdoor

Behavior Changes/Concerns

Previous Veterinary Facility Information

Previous Medical History/Conditions

Previous Vaccination History

Vaccine Reaction History

Known Allergies

Current Medications

Current Supplements

Current Preventatives (Heartworm; Flea/Tick)

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Ready to visit?

We proudly serve the pets of Virginia Beach, Norfolk, Portsmouth, and Suffolk. Easily request an appointment for your pet using our online system!

Appointment

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Questions?

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Location

1615 Volvo Parkway
Chesapeake, VA 23320

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Contact Us

Phone: 757-549-8609
Email: hvcpetportals@aol.com

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Hours

Mon-Fri: 8:00 AM-6:00 PM
Sat: 8:00 AM - 12:00 PM
Open the first and third Saturdays of the month

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Android: Google Play Store
iOS: App Store

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Email *

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