New Client Registration Form

Name *

First

Last

Spouse's Name

First

Last

E-mail

(To receive a copy of med record and visit/pet related information)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone - Home *

Cell Phone

Work Phone

Nearest relative not living with you:

First

Last

(This is requested for when a medical decision must be made for your pet, but despite our best efforts we cannot get in touch with you.)

Phone

Driver's license/ID # and State *

(Receptionist required to make photocopy of license.)

Are you an active or former police officer/fire fighter/military personnel?

Yes
No

Are you a senior citizen (65 years or older)?

Yes
No

Are you a Cone Health Employee or full-time Guilford County Schools Employee?

Yes
No

Do you have pet insurance?

Yes
No

Name of regular DVM (Veterinary) hospital: *

Please write "No Vet" if this doesn't apply

Reason for your pet’s visit to Happy Tails: *

How did you hear about Happy Tails Veterinary Emergency Clinic? (Please check all that apply) *

Patient Information

Pet #1 Name:

Age or DOB

Breed

Color(s)

Sex

Male
Female

Spayed/Neutered?

Yes
No

Is your pet on any medications? Please list:

Is your pet on a special diet?

Is your pet up to date on vaccines and heart worm prevention?

Does your pet have any allergies?

Additional Patient Information

Pet #2 Name:

Age or DOB

Breed

Color(s)

Sex

Male
Female

Spayed/Neutered?

Yes
No

Is your pet on any medications? Please list:

Is your pet on a special diet?

Is your pet up to date on vaccines and heart worm prevention?

Does your pet have any allergies?

At times we take photos of our patients for educational or uplifting purposes to be used on our social media or website. *

Yes, I consent for my pet’s photos/information to be used by Happy Tails Veterinary Emergency
No, I do not consent

Signature *

PAYMENT DUE WHEN SERVICES ARE RENDERED – OPTIONS: CASH, CHECK, CARE CREDIT, & ALL MAJOR CREDIT CARDS.

Date: *

Comment

We are always ready to help!

Scroll down for our contact information. Our experienced emergency veterinary team is here for your pet’s needs.

We’re here nights, weekends, and holidays for your pet.

Location

2936 Battleground Avenue
Greensboro, NC 27408
Click here for directions.

After Hours Care

Office Hours:
Mon: 6:00pm – 8:00am
Tues: 6:00pm – 8:00am
Wed: 6:00pm – 8:00am
Thurs: 6:00pm – 8:00am
Fri: 6:00pm – 8:00am
Sat: 24 hours
Sun: 24 hours

Contact Us

Call us: 336-288-2688
Fax us: 336-288-2686
Email us: happytailser@gmail.com

We are open 24 hours on holidays
After regular business hours - Guardian Vets is here!
We are pleased to provide extended hours emergency consultations from a licensed veterinary professional. These individuals will help you determine if you will need to bring your pet in for veterinary care. To reach one of our on-call professionals:

Call our main number: (336) 288-2688
When prompted, press 1.
Your call will automatically be connected to a licensed veterinary professional who will triage the emergency. No sitting on hold, no leaving a message with a service.

Have questions? We’re here to help!

Please complete the form below and a member of our team will respond generally within 24 hours. If you’re in the middle of an emergency situation, please call us at 336-288-2688.